Acute shock with encephalopathy and multiorgan failure (ASEM)
General description
Acute shock with encephalopathy and multiorgan failure (ASEM), formerly known as hemorrhagic shock and encephalopathy syndrome (HSES), is a severe condition caused by a cytokine storm, typically triggered by a viral infection. This excessive immune response results in widespread inflammation and systemic organ damage, including the brain, kidneys, liver, lungs, heart, and coagulation system. Patients commonly present with fever, shock, and watery diarrhea, along with disseminated intravascular coagulation (DIC). The condition manifests with neurological symptoms such as seizures and impaired consciousness, as well as bleeding tendencies and dysfunction of multiple organs, leading to a poor prognosis.
Cortical involvement
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CerebrumCerebral cortex
MRI reveals cortical T2WI and FLAIR hyperintensities with swellings, T1WI hyperintensity on T1WI reflecting laminar necrosis, and contrast effect on T1WI.
Bright tree appearance like lesion
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CerebrumFrontal lobeCerebral white matterSubcortical white matterU-fiber
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CerebrumParietal lobeCerebral white matterSubcortical white matterU-fiber
DWI and T2WI reveal hyperintensity along the subcortical U-fibers, resembling the 'bright tree appearance'.