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Clinical and MRI features of neurological complications after influenza A (H1N1) infection in critically ill children

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Abstract

Background

Influenza A (H1N1) can cause severe neurological complications.

Objective

The purpose of this study was to analyze clinical and MRI features of neurological complications after H1N1 infection in critically ill children.

Materials and methods

We retrospectively analyzed clinical and neuroimaging findings in 17 children who were hospitalized in an intensive care unit with severe neurological complications after H1N1 infection in South China between September 2009 and December 2011. All children underwent pre- and post-contrast-enhanced brain MRI. Postmortem studies were performed in two children.

Results

Six children died, five because of acute necrotizing encephalopathy (ANE) and one because of intracranial fungal infection. Eleven recovered; their manifestations of H1N1 were meningitis (3), encephalitis (1) and influenza encephalopathy (7). MRI features of ANE included multiple symmetrical brain lesions demonstrating prolonged T1 and T2 signal in the thalami, internal capsule, lenticular nucleus and pontine tegmentum. Postmortem MRI in two children with acute necrotizing encephalopathy showed diffuse prolonged T1 and T2 signal in the bilateral thalami, brainstem deformation and tonsillar herniation.

Conclusion

Fatal neurological complications in children after H1N1 infection include ANE and opportunistic fungal infection. MRI is essential for identification of neurological complications and for clinical evaluation.

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References

  1. Ekstrand JJ, Herbener A, Rawlings J et al (2010) Heightened neurologic complications in children with pandemic H1N1 influenza. Ann Neurol 68:762–766

    Article  PubMed  Google Scholar 

  2. Lee YJ, Smith DS, Rao VA et al (2011) Fatal H1N1-related acute necrotizing encephalopathy in an adult. Case Reports Crit Care 2011:1–4

    Article  Google Scholar 

  3. Lyon JB, Remigio C, Milligan T et al (2010) Acute necrotizing encephalopathy in a child with H1N1 influenza infection. Pediatr Radiol 40:200–205

    Article  PubMed  Google Scholar 

  4. Nowak DA, Griebl G, Bock A (2011) Acute myelopathy associated with H1N1 virus infection. J Neurol 258:34–36

    Article  PubMed  Google Scholar 

  5. Ormitti F, Ventura E, Summa A et al (2010) Acute necrotizing encephalopathy in a child during the 2009 influenza A (H1N1) pandemia: MR imaging in diagnosis and follow-up. AJNR Am J Neuroradiol 31:396–400

    Article  PubMed  CAS  Google Scholar 

  6. Haktanir A (2010) MR imaging in novel influenza A (H1N1)-associated meningoencephalitis. AJNR Am J Neuroradiol 31:394–395

    Article  PubMed  CAS  Google Scholar 

  7. Kimura S, Ohtuki N, Nezu A et al (1998) Clinical and radiological variability of influenza-related encephalopathy or encephalitis. Acta Paediatri Jpn 40:264–270

    Article  CAS  Google Scholar 

  8. Mizuguchi M (1997) Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan and Taiwan. Brain Dev 19:81–92

    Article  PubMed  CAS  Google Scholar 

  9. Hasegawa S, Matsushige T, Inoue H et al (2011) Serum and cerebrospinal fluid cytokine profile of patients with 2009 pandemic H1N1 influenza virus-associated encephalopathy. Cytokine 54:167–172

    Article  PubMed  CAS  Google Scholar 

  10. Mariotti P, Iorio R, Frisullo G et al (2010) Acute necrotizing encephalopathy during novel influenza A (H1N1) virus infection. Ann Neurol 68:111–114

    Article  PubMed  Google Scholar 

  11. Wong AM, Simon EM, Zimmerman RA et al (2006) Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome. AJNR Am J Neuroradiol 27:1919–1923

    PubMed  CAS  Google Scholar 

  12. Kim JH, Kim IO, Lim MK et al (2004) Acute necrotizing encephalopathy in Korean infants and children: imaging findings and diverse clinical outcome. Korean J Radiol 5:171–177

    Article  PubMed  Google Scholar 

  13. Harms PW, Schmidt LA, Smith LB et al (2010) Autopsy findings in eight patients with fatal H1N1 influenza. Am J Clin Pathol 134:27–35

    Article  PubMed  Google Scholar 

  14. Steininger C, Popow-Kraupp T, Laferl H et al (2003) Acute encephalopathy associated with influenza A virus infection. Clin Infect Disease 36:567–574

    Article  Google Scholar 

  15. Wang HS, Huang SC (2001) Acute necrotizing encephalopathy of childhood. Chang Gung Med J 24:1–10

    PubMed  CAS  Google Scholar 

  16. Mizuguchi M, Abe J, Mikkaichi K et al (1995) Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions. J Neurol Neurosurg Psychiatry 58:555–561

    Article  PubMed  CAS  Google Scholar 

  17. Yagishita A, Nakano I, Ushioda T et al (1995) Acute encephalopathy with bilateral thalamotegmental involvement in infants and children: imaging and pathology findings. AJNR Am J Neuroradiol 16:439–447

    PubMed  CAS  Google Scholar 

  18. Aiba H, Mochizuki M, Kimura M et al (2001) Predictive value of serum interleukin-6 level in influenza virus-associated encephalopathy. Neurology 57:295–299

    Article  PubMed  CAS  Google Scholar 

  19. Ichiyama T, Endo S, Kaneko M et al (2003) Serum cytokine concentrations of influenza-associated acute necrotizing encephalopathy. Pediatri Int 45:734–736

    Article  CAS  Google Scholar 

  20. Sugaya N (2000) Influenza-associated encephalopathy in Japan: pathogenesis and treatment. Pediatr Int 42:215–218

    Article  PubMed  CAS  Google Scholar 

  21. Morishima T, Togashi T, Yokota S et al (2002) Encephalitis and encephalopathy associated with an influenza epidemic in Japan. Clin Infect Dis 35:512–517

    Article  PubMed  Google Scholar 

  22. Mizuguchi M, Hayashi M, Nakano I et al (2002) Concentric structure of thalamic lesions in acute necrotizing encephalopathy. Neuroradiology 44:489–493

    Article  PubMed  CAS  Google Scholar 

  23. Albayram S, Bilgi Z, Selcuk H et al (2004) Diffusion-weighted MR imaging findings of acute necrotizing encephalopathy. AJNR Am J Neuroradiol 25:792–797

    PubMed  Google Scholar 

  24. Voudris KA, Skaardoutsou A, Haronitis I et al (2001) Brain MRI findings in influenza A-associated acute necrotizing encephalopathy of childhood. Eur J Paediatr Neurol 5:199–202

    Article  PubMed  CAS  Google Scholar 

  25. Wang J, Duan S, Zhao J et al (2011) Acute disseminated encephalomyelitis associated with influenza A H1N1 infection. Neurol Sci 32:907–909

    Article  PubMed  Google Scholar 

  26. Spalice A, Del Balzo F, Nicita F et al (2011) Teaching NeuroImages: acute necrotizing encephalopathy during novel influenza A (H1N1) virus infection. Neurology 77:e121

    Article  PubMed  CAS  Google Scholar 

  27. Takanashi J, Takahashi Y, Imamura A et al (2012) Late delirious behavior with 2009 H1N1 influenza: mild autoimmune-mediated encephalitis? Pediatrics 129:e1068–e1071

    Article  PubMed  Google Scholar 

  28. Hosseinnezhad A, Rapose A (2012) Cryptococccal meningoencephalitis after H1N1 influenza. BMJ Case Rep. doi:10.1136/bcr.11.2011.5224

    PubMed  Google Scholar 

  29. Roberts DJ, Kelly JJ, Midha R et al (2011) Cerebral abscesses resulting from H1N1 influenza with staphylococcal co-infection. Can J Neurol Sci 38:147–150

    PubMed  Google Scholar 

  30. Zuccoli G, Siddiqui N, Bailey A et al (2010) Neuroimaging findings in pediatric Wernicke encephalopathy: a review. Neuroradiology 52:523–529

    Article  PubMed  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Department of Radiology, Shenzhen Children’s Hospital, Guangdong, China

    Hongwu Zeng & Yungen Gan

  2. 7019 Yitian Road, Futian District, Shenzhen City, Guangdong, China, 518026

    Yungen Gan

  3. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Stephen Quinet & Yonker Wang

  4. 3620 Wolf Trap Court, Brookfield, WI, 63045, USA

    Yonker Wang

  5. Department of Respiratory Medicine, Shenzhen Children’s Hospital, Guangdong, China

    Wenxian Huang

  6. Department of Pathology, Shenzhen Children’s Hospital, Guangdong, China

    Chunxi Han

  7. Pediatric Intensive Care Unit, Shenzhen Children’s Hospital, Guangdong, China

    Yanxia He

Authors
  1. Hongwu Zeng
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  2. Stephen Quinet
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  3. Wenxian Huang
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  4. Yungen Gan
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  5. Chunxi Han
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  6. Yanxia He
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  7. Yonker Wang
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Corresponding authors

Correspondence to Yungen Gan or Yonker Wang.

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Zeng, H., Quinet, S., Huang, W. et al. Clinical and MRI features of neurological complications after influenza A (H1N1) infection in critically ill children. Pediatr Radiol 43, 1182–1189 (2013). https://doi.org/10.1007/s00247-013-2682-5

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  • DOI: https://doi.org/10.1007/s00247-013-2682-5

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