Hemorrhagic shock and encephalopathy. Clinical definition of a catastrophic syndrome in infants
E. Chaves-Carballo, J. E. Montes, W. B. Nelson and B. A. Chrenka
Department of Neurology, Eastern Virginia Medical School, Norfolk.
We treated nine infants who unexpectedly developed shock, seizures, and
fever, followed by diarrhea, consumption coagulopathy, and hepatorenal
dysfunction. Despite vigorous treatment, three infants died and all except
one of the six survivors have severe residual neurologic abnormalities.
Postmortem findings included cerebral edema, white matter petechial
hemorrhages, gastrointestinal hemorrhages, and fatty liver. These
clinicopathologic features are similar to those previously described in 10
infants as being due to hemorrhagic shock and encephalopathy, except for
the presence of fatty liver in our patients. Based on the combined
experience of 19 infants, we propose diagnostic criteria for hemorrhagic
shock and encephalopathy that may facilitate recognition and
differentiation from other shock syndromes in infancy.
