Criteria

Reye Syndrome 1990 case definition[24]

Reye syndrome is defined as an illness that meets all the following criteria:

  • Acute, noninflammatory encephalopathy with either sterile CSF containing <9 WBCs/mL or cerebral edema without inflammation evident on histology

  • Hepatic dysfunction documented by either a threefold elevation of serum transaminases and/or ammonia or liver biopsy demonstrating fatty infiltration

  • No other diagnosis to account for the cerebral and hepatic derangement.

Clinical stages (modified from Hurwitz)[2]

The National Reye Syndrome Surveillance System has described increasing stages of severity:

  • Stage 1: Lethargic, vomiting

  • Stage 2: Irritable, delirious, hyperreflexive, positive Babinski sign, dilated/sluggish pupils, responsive to pain

  • Stage 3: Decorticate posturing, obtunded, unresponsive to pain

  • Stage 4: Decerebrate posturing, comatose, fixed/dilated pupils

  • Stage 5: Areflexia, flaccid paralysis, unresponsive pupils, seizures, respiratory failure

  • Stage 6: Patient cannot be classified as he/she has been treated with curare or another medication that alters the level of consciousness.

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