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An Outbreak of Encephalopathy after Eating Autumn Mushroom(Sugihiratake ; Pleurocybella porrigens) in Patients with Renal Failure : A Clinical Analysis of Ten Cases in Yamagata, Japan Takeo Kato 1 , Toru Kawanami 1 , Hiroshi Shimizu 2 , Katsuro Kurokawa 3 , Hiroyasu Sato 3 , Katsuo Nakajima 3 , Tatsuya Nomoto 4 , Takehiro Seta 4 , Tetsumasa Kamei 5 , Hiide Yoshino 5 , Isoji Sasagawa 5 , Minoru Ito 6 , Shigeru Karasawa 7 , Hideki Kimura 8 , Yoshihiro Suzuki 8 , Noriyuki Degawa 8 , Asako Tagawa 9 , Ken Ataka 9 , Shiori Ando 10 , Tomoya Omae 10 , Yukihiro Shikama 11 1Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetes(DNHMED), Yamagata University School of Medicine 2Department of Health Policy Science, Yamagata University Graduate School of Medical Science 3Department of Internal Medicine, Yamagata Prefectural Shinjo Hospital 4Department of Neurology, Kitamurayama Hospital 5Departments of Neurology and Urology, Yamagata Tokushukai Hospital 6Department of Internal Medicine, Public Okitama General Hospital 7Department of Neurology, Yamagata Prefectural Central Hospital 8Departments of Neurology and Internal Medicine, Yamagata Prefectural Nihonkai Hospital 9Departments of Neurology and Internal Medicine, Tsuruoka Municipal Shonai Hospital 10Departments of Neurology and Neurosurgery, Shonai Amarume Hospital 11Department of Neurology, Yamagata Prefectural Kahoku Hospital Keyword: hemodialysis , Pleurocybella porrigens , consciousness disturbance , seizure , basal ganglia , insula , encephalopathy , periodic synchronous discharge:PSD , MRI pp.999-1007
Published Date 2004/12/1
DOI https://doi.org/10.11477/mf.1406100367
  • Abstract
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 In September and October, 2004, an outbreak of encephalopathy of unknown etiology occurred in certain areas of Japan including Yamagata, Akita, and Niigata prefectures. These patients had a history of chronic renal failure, most of them had undergone hemodialysis, and also had a history of eating Sugihiratake(Pleurocybella porrigens), an autumn mushroom without known toxicity. Since clinical details of this type of encephalopathy remain unknown, we analyzed the clinical, radiological and electroencephalographic(EEG) features of ten cases of this encephalopathy in Yamagata prefecture. The summary of the present study is as follows :

1.Ten patients had chronic renal failure, and seven underwent hemodialysis.

2.Each patient had a history of eating Sugihiratake within 2-3 weeks of the onset of neurological symptoms.

3.The onset was subacute ; the initial symptoms were tremor, dysarthria, and/or weakness of the extremities, which lasted an average of 4.5 days(ranging from 2 to 11 days), followed by severe consciousness disturbance and intractable seizures, resulting in status epilepticus in 5 patients. Myoclonus was also seen in 4 patients and Babinski reflex in 3.

4.Brain CT and MRI examinations were unremarkable in the early stages of the disease. Three to eight days after onset, however,conspicuous lesions appeared in the areas of the insula and basal ganglia in 6 patients. On MRI, these brain lesions were hyperintense on T2-weighted and FLAIR images, and hypointense on T1-weighted images.

5.EEG examination was performed in 6 patients, all of whom showed abnormal EEG findings. Periodic synchronous discharge(PSD) was seen in 2 patients, spike and wave complex in one patient, and non-specific slow waves in 3.

6.Prognosis was different from case to case. Three patients died at 13, 14, and 29 days after onset. Two patients still showed persistent disturbance of consciousness one month after onset. One patient showed parkinsonism after recovering from consciousness disturbance. Four patients recovered nearly completely around one month after onset. In 3 of the 4 recovered patients, renal failure was not severe and they did not need to undergo hemodialysis. This suggests that the degree of renal failure is a key for the prognosis of this type of encephalopathy.

The present study suggests that this endemic disease is a newly recognized clinical entity of encephalopathy.(Received : December 9, 2004)


Copyright © 2004, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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