Because of the relatively diffuse diagnostic picture and the large number of diseases with similar symptoms, very strict rules should be applied when diagnosing Reye's syndrome in adults. There is a typical biphasic course with severe vomiting and a non-inflammatory encephalopathy in the second phase. There are clear increases in enzyme activity (GPT, GOT, GLDH), and in the case of GLDH the possibility of a lower molecular inhibitor should be considered plus an increase in the serum ammonia level. There is also a fine droplet fatty degeneration of the liver with centralised nuclei although without a preference for specific sites and without any basic signs of inflammation. Electron microscopy shows signs of mitochondrial injury and histochemical examination shows a lowered mitochondrial enzyme activity. If not all of these criteria are met a further clarification of the disease picture requires that at most there is a suspicion of a Reye's syndrome.
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