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.

Cortical Vision Loss as a Prominent Feature of H1N1 Encephalopathy

“…This strain clinically manifested mainly with respiratory problems, especially in young people. In our patient, the elevated protein but otherwise unremarkable CSF is consistent with the CSF profile from other H1N1 encephalopathy patients (6,10). Focal neurologic problems such as hemisensory loss caused from H1N1 were less commonly reported (4,5).…”

Cortical Vision Loss as a Prominent Feature of H1N1 Encephalopathy

“…This strain clinically manifested mainly with respiratory problems, especially in young people. In our patient, the elevated protein but otherwise unremarkable CSF is consistent with the CSF profile from other H1N1 encephalopathy patients (6,10). Focal neurologic problems such as hemisensory loss caused from H1N1 were less commonly reported (4,5).…”

H1N1 Encephalitis with Malignant Edema and Review of Neurologic Complications from Influenza

“…The neurologist Oliver Sacks [55] drew attention to this mysterious disorder and the discovery of L-dopa, in his book, Awakenings later converted to a feature-length movie. The delayed appearance of restricted diffusion in the basal ganglia in our patient and others [35] is concerning for this condition (Fig. 2).…”

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.…”

Cortical Vision Loss as a Prominent Feature of H1N1 Encephalopathy

“…This strain clinically manifested mainly with respiratory problems, especially in young people. In our patient, the elevated protein but otherwise unremarkable CSF is consistent with the CSF profile from other H1N1 encephalopathy patients (6,10). Focal neurologic problems such as hemisensory loss caused from H1N1 were less commonly reported (4,5).…”

H1N1 Encephalitis with Malignant Edema and Review of Neurologic Complications from Influenza

“…The neurologist Oliver Sacks [55] drew attention to this mysterious disorder and the discovery of L-dopa, in his book, Awakenings later converted to a feature-length movie. The delayed appearance of restricted diffusion in the basal ganglia in our patient and others [35] is concerning for this condition (Fig. 2).…”

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.…”

Cortical Vision Loss as a Prominent Feature of H1N1 Encephalopathy

“…This strain clinically manifested mainly with respiratory problems, especially in young people. In our patient, the elevated protein but otherwise unremarkable CSF is consistent with the CSF profile from other H1N1 encephalopathy patients (6,10). Focal neurologic problems such as hemisensory loss caused from H1N1 were less commonly reported (4,5).…”

H1N1 Encephalitis with Malignant Edema and Review of Neurologic Complications from Influenza

“…The neurologist Oliver Sacks [55] drew attention to this mysterious disorder and the discovery of L-dopa, in his book, Awakenings later converted to a feature-length movie. The delayed appearance of restricted diffusion in the basal ganglia in our patient and others [35] is concerning for this condition (Fig. 2).…”

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.…”