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Definition

Reye syndrome is characterized by sudden (acute) brain damage and liver function problems. This condition does not have a known cause.

This syndrome has occurred in children who were given aspirin when they had chickenpox or the flu. Reye syndrome has become very rare. This is because aspirin is no longer recommended for routine use in children.

Causes

There is no known cause of Reye syndrome. It is most often seen in children ages 4 to 12. Most cases that occur with chickenpox are in children ages 5 to 9. Cases that occur with the flu are most often in children ages 10 to 14.

Symptoms

Children with Reye syndrome get sick very suddenly. The syndrome often begins with vomiting. It may last for many hours. The vomiting is quickly followed by irritable and aggressive behavior. As the condition gets worse, the child may be unable to stay awake and alert.

Other symptoms of Reye syndrome:

• Confusion
• Lethargy
• Loss of consciousness or coma
• Mental changes
• Nausea and vomiting
• Seizures
• Unusual placement of arms and legs (decerebrate posture). The arms are extended straight and turned toward the body, the legs are held straight, and the toes are pointed downward

Other symptoms that can occur with this disorder include:

• Double vision
• Hearing loss
• Muscle function loss or paralysis of the arms or legs
• Speech difficulties
• Weakness in the arms or legs

Exams and Tests

The following tests may be used to diagnose Reye syndrome:

• Blood chemistry tests
• Head CT or head MRI scan
• Liver biopsy
• Liver function tests
• Serum ammonia test
• Spinal tap

Treatment

There is no specific treatment for this condition. The health care provider will monitor the pressure in the brain, blood gases, and blood acid-base balance (pH).

Treatments may include:

• Breathing support (a breathing machine may be needed during a deep coma)
• Fluids by IV to provide electrolytes and glucose
• Steroids to reduce swelling in the brain

Outlook (Prognosis)

How well a person does depends on the severity of any coma, as well as other factors.

The outcome for those who survive an acute episode may be good.

Possible Complications

Complications may include:

• Coma
• Permanent brain damage
• Seizures

When untreated, seizures and coma may be life threatening.

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) immediately if your child has:

• Confusion
• Lethargy
• Other mental changes

Prevention

Never give a child aspirin unless told to do so by your child's provider.

When a child must take aspirin for a medical condition, take care to reduce the child's risk of catching a viral illness, such as the flu and chickenpox. Avoid aspirin for several weeks after the child has received a varicella (chickenpox) vaccine.

Note: Other over-the-counter medicines, such as Pepto-Bismol and substances with oil of wintergreen also contain aspirin compounds called salicylates. DO NOT give these to a child who has a cold or fever.

References

Aronson JK. Acetylsalicylic acid. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier B.V.; 2016:26-52.

Cherry JD. Reye syndrome. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 50.

Johnston MV. Encephalopathies. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 616.

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