Lumbar puncture (spinal tap)
During a spinal tap (lumbar puncture) procedure, you typically lie on your side with your knees drawn up to your chest. A needle is then inserted into your spinal canal — between two vertebrae in your lower back — to collect cerebrospinal fluid (CSF) for testing.
There's no specific test for Reye's syndrome. Instead, screening for Reye's syndrome usually begins with blood and urine tests as well as testing for fatty acid oxidation disorders and other metabolic disorders.
Sometimes more-invasive diagnostic tests are needed to evaluate other possible causes of liver problems and investigate any neurological abnormalities. For example:
Spinal tap (lumbar puncture). A spinal tap can help the doctor identify or rule out other diseases with similar signs and symptoms, such as infection of the lining that surrounds the brain and spinal cord (meningitis) or inflammation or infection of the brain (encephalitis).
During a spinal tap, a needle is inserted through the lower back into a space below the end of the spinal cord. A small sample of cerebrospinal fluid is removed and sent to a lab for analysis.
Liver biopsy. A liver biopsy can help the doctor identify or rule out other conditions that may be affecting the liver.
During a liver biopsy, a needle is inserted through the skin on the upper right side of the abdomen and into the liver. A small sample of liver tissue is removed and sent to a lab for analysis.
Computerized tomography (CT) scan or magnetic resonance imaging (MRI). A head CT or MRI scan can help the doctor identify or rule out other causes of behavior changes or decreased alertness.
A CT scan uses a sophisticated imaging machine linked to a computer to produce detailed images of the brain. An MRI scan uses a strong magnetic field and radio waves rather than X-rays to generate images of the brain.
Skin biopsy. Testing for fatty acid oxidation disorders or metabolic disorders may require a skin biopsy, although direct gene sequencing together with blood and urine tests are often sufficient to make such a diagnosis.
During a skin biopsy, a doctor takes a small skin sample for analysis in a lab. A biopsy can usually be done in a doctor's office using a local anesthetic.
Reye's syndrome is usually treated in the hospital. Severe cases may be treated in the intensive care unit. The hospital staff will closely monitor your child's blood pressure and other vital signs. Specific treatment may include:
- Intravenous fluids. Glucose and an electrolyte solution may be given through an intravenous (IV) line.
- Diuretics. These medications may be used to decrease intracranial pressure and increase fluid loss through urination.
- Medications to prevent bleeding. Bleeding due to liver abnormalities may require treatment with vitamin K, plasma and platelets.
- Cooling blankets. This intervention helps maintain internal body temperature at a safe level.
If your child has trouble breathing, he or she may need assistance from a breathing machine (ventilator).
Preparing for your appointment
Reye's syndrome is often diagnosed in an emergency situation because of serious signs and symptoms, such as seizures or loss of consciousness. In some cases, early signs and symptoms prompt a doctor's appointment.
You'll likely be referred to a doctor who specializes in conditions of the brain and nervous system (neurologist).
Because appointments can be brief and there's often a lot of ground to cover, it can help to be well prepared. Here are some tips to help you get ready for your appointment.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
- Write down any symptoms your child is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Make a list of all medications, including vitamins, dietary supplements and over-the-counter drugs, that your child has taken, especially any containing aspirin. Even better, take the original bottles and a written list of the dosages and directions.
- Take along a family member or friend. It can be difficult to recall all the information provided to you during an appointment. The person who accompanies you may remember something that you forgot or missed.
- Write down questions to ask your doctor. Don't be afraid to ask questions or to speak up when you don't understand something your doctor says.
List your questions from most important to least important in case your time with your doctor runs out. For Reye's syndrome some basic questions to ask your doctor include:
- What are other possible causes for my child's symptoms?
- What tests are needed to confirm the diagnosis?
- What are the treatment options and the pros and cons for each?
- What results can I expect?
- What kind of follow-up should I expect?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
The neurologist is likely to ask about your child's symptoms and history of viral illnesses. The doctor will also conduct a medical exam and schedule tests to gather information about your child's condition and to rule out other diseases, such as meningitis or encephalitis.
Aug. 15, 2020
- Stone CK, et al., eds. Neurologic emergencies. In: Current Diagnosis & Treatment: Emergency Medicine. 8th ed. New York, N.Y.: McGraw-Hill Education; 2017. https://www.accessmedicine.mhmedical.com. Accessed May 24, 2018.
- Ropper AH, et al. The acquired metabolic disorders of the nervous system. In: Adams and Victor's Principles of Neurology. 10th ed. New York, N.Y.: McGraw-Hill Education; 2014. https://accessmedicine.mhmedical.com. Accessed May 24, 2018.
- What is Reye's syndrome? National Reye's Syndrome Foundation. http://www.reyessyndrome.org/what.html. Accessed May 24, 2018.
- Reye syndrome. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/miscellaneous-disorders-in-infants. Accessed May 24, 2018.
- Reye syndrome. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/reye-syndrome/. Accessed May 24, 2018.
- What is the role of aspirin in triggering Reye's? National Reye's Syndrome Foundation. http://www.reyessyndrome.org/aspirin.html. Accessed June 22, 2018.
- Reye's and chickenpox. National Reye's Syndrome Foundation. http://www.reyessyndrome.org/chickenpox.html. Accessed June, 22, 2018.
- Patterson MC (expert opinion). Mayo Clinic. Aug. 6, 2020.