Acute Hemorrhagic Leukoencephalitis and Hypoxic Brain Injury Associated With H1N1 Influenza

Abstract

A 40-year-old man with severe H1N1 influenza infection with prolonged hypoxia and critical illness who remained comatose after withdrawal of sedatives and paralytics. Interventions: Clinical examination and magnetic resonance imaging. Results: Brain imaging revealed multifocal T2 hyperintense lesions, edema, and hemorrhages consistent with acute hemorrhagic leukoencephalitis (AHL) and restricted diffusion in the basal ganglia consistent with hypoxic brain injury. The patient remained in a severely disabled state following treatment with plasma exchange and high-dose corticosteroids. Conclusions: This is the first study of neurologic complications associated with H1N1 influenza infection in adults. Severe brain injury can occur by 2 distinct mechanisms: a fulminant autoimmune demyelinating insult (AHL) and hypoxic brain injury. Clinicians should be aware of these potential complications so that appropriate imaging and treatment can be considered.

Acute hemorrhagic leukoencephalopathy associated with influenza A (H1N1) virus

“…From a radiological point of view, our case provides interesting data, since acute hemorrhagic leukoencephalopathy is rarely encountered in association with the H1N1 virus [5]. However, this patient does not correspond to any of the five categories of influenza-related encephalopathy or encephalitis proposed by Kimura et al, or to the two encephalitis/encephalopathy syndromes newly identified by Takanashi [6,7].…”

Acute Hemorrhagic Leukoencephalitis (Hurst Disease) Secondary to H1N1 in a Child - A Story of Full Recovery from Qatar, A Case Report

“…The cases reported in the literature linking AHLE to H1N1 were mostly among adult population [6][7][8]. Our case has been proved to have novel H1N1 infection confirmed by PCR testing of her respiratory secretions.…”

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

“…A high proportion of patients with ADEM, especially children, are found to have antibodies directed toward myelin oligodendrocytes glycoprotein [63][64][65][66]. AHLE has been reported to occur in the context of several different viral infections, including cytomegalovirus, Epstein Barr virus, herpes simplex virus, the mumps virus, and the H1N1 virus [67][68][69][70][71].…”