Nuclear Tomographic Imaging and Nutritional Rehabilitation for Cerebral Functions follow up in Kwashiorkor

Background and aims: Kwashiorkor represents a group of related disorders known as protein-energy malnutrition (PEM), it is associated with cerebral changes which consequently would give rise to intellectual and developmental delay. The present study seeks to define and document cerebral changes and abnormalities in a sample of infants with kwashiorkor using brain imaging.

Methods: Prospective cohort study included 20 infants had admitted to the children hospital Ain Shams University, Cairo, Egypt for treatment of Kwashiorkor aged 4–18 months compared to 5 normal weight matched age infants as control. Clinical assessment, laboratory investigation, brain computed tomography and 99m-HMPAO brain SPECT was done for all infants twice; first on admission and repeated after 10-12 weeks of nutritional rehabilitation.

Results: Most infants with moderate disease and all infants with severe disease showed significant cerebral changes and hypoperfusion in certain areas of the brain, which significantly resolved after nutritional rehabilitation in all infants except one with sever disease. A positive correlation was found between severity of the disease and extent of cerebral hypoperfusion.

Conclusions: Kwashiorkor is associated with cerebral atrophy and impaired dynamic functional activity of the brain that may be detrimental to intellectual development; brain SPECT is more accurate in assessing deleterious effect of PEM on growing brain.