"They are thought to be driven by infection-triggered cytotoxicity and a cytokine storm in the CNS and are distinct from both primary encephalitides (by absence of direct brain parenchymal infection) and post-infectious autoimmune encephalitides (by the ongoing presence of the infection at the time of symptom onset) 1."
"acute encephalopathy with biphasic seizures and late restricted diffusion (AESD) 2"
"acute leukoencephalopathy with restricted diffusion (ALERD) is sometimes considered a subgroup of AESD where the bright tree appearance is present 1"
"A possible ITES is diagnosed when the core criteria are met, other than the presence of supporting radiological findings 1. This diagnosis must be supported by EEG findings suggestive of encephalopathy or elevated CSF neuroinflammatory biomarkers. Both non-convulsive status epilepticus and transient delirium associated with fever must be excluded."
"EEG is typically abnormal and may show slowing or epileptiform activity. CSF analysis (unlike in infectious or autoimmune encephalitis) does not show oligoclonal bands and usually does not show pleocytosis or evidence of microorganisms."
"Two epileptic syndromes, FIRES and hemiconvulsion-hemiplegia-epilepsy syndrome, have strong similarities to ITES and may ultimately have similar biological mechanisms 1."
"AESD/ALERD: initially normal imaging progresses to diffusion restriction in the subcortical white matter (bright tree appearance) alongside subcortical T2 and FLAIR hyperintensity 2"
"haemorrhagic shock and encephalopathy syndrome (HSES) /acute shock with encephalopathy and multiorgan failure (ASEM) 6"
Expected headings
"Core criteria"
"Possible ITES"
"Infection-triggered encephalopathy syndromes (ITES) are a group of five syndromes characterised clinically by acute-onset para-infectious encephalopathy, with or without seizures 1. They are most common in infants and children and can be triggered by numerous different infectious agents."
"a clinical presentation of decreased or altered level of consciousness, altered mental status, lethargy or personality change lasting for 24 hours"
"All ITES conditions are characterised by a febrile illness followed by relatively rapid onset of encephalopathy (acute onset of decreased consciousness or altered mental status) 1. It is typical for fever to still be present at the time of onset of neurological symptoms. Seizures are a common feature. The ultimate clinical course is determined by the syndrome subtype, ranging from self-limiting (e.g. MERS) to rapidly fatal (e.g. ASEM)."