Acute necrotizing encephalopathy during novel influenza A (H1N1) virus infection

Abstract

A novel swine-origin influenza A (H1N1) virus was recently identified in Mexico. Some cases of infection with neurological complications have been reported to date. We report a case of acute necrotizing encephalopathy associated with the novel H1N1 virus in a 2-year-old European girl who suddenly developed fever, seizures, and altered mental status. Brain and spinal cord magnetic resonance imaging showed bilateral symmetrical lesions of the insulae, thalami, geniculate bodies, and pons tegmentum suggestive of an acute necrotizing encephalopathy. An involvement of meninges and spinal cord was observed configuring an acute necrotizing meningoencephalomyelitis.

Neurological complications of pandemic influenza A H1N1 2009 infection: European case series and review

“…The third patient, with ANE, made complete recovery (case 2). This clinical outcome is unusual when compared with reported cases [2,23,24,26,33,45] but cannot be attributed to any individual therapeutic intervention given the complex multi-therapeutic interventions the child received concurrently.…”

Severe form of encephalopathy associated with 2009 pandemic influenza A (H1N1) in Japan

“…12 Pre-existing conditions were present in about a half of the patients in some reports, 13,16,18 whereas no pre-existing conditions were seen in several case reports and case series of acute encephalopathy with pH1N1. 14,15,17,[19][20][21][22][23][24] These conflicting data indicate that further studies are necessary to clarify the relationship between pre-existing conditions and acute encephalopathy.…”

Neurology of the H1N1 pandemic in Singapore: a nationwide case series of children and adults

“…These severe complications, fortunately rare, have been reported to occur in patients with pH1N1 (Fugate et al 2010;Mariotti et al 2010;Akins et al 2010;Kahle et al 2011) and other strains of influenza (Morishima et al 2002;Steininger et al 2003;Amin et al 2008;Huang et al 2009). Another two patients suffered unusual manifestations of acute transverse myelitis and BIH.…”

“…At-risk groups include children with chronic heart and lung diseases, elderly, smokers, pregnant women, and transplant recipients (Studahl 2003). As pH1N1 progressed, mild and severe neurological complications have been reported to occur in children (Centers for Disease Control and Prevention (CDC) 2009a; Baltagi et al 2010;Mariotti et al 2010;Ekstrand et al 2010;Landau et al 2011;Rellosa et al 2011;Kedia et al 2011;Yildizdaş et al 2011;Ozkan et al 2011;Farooq et al 2012) and adults (Tan et al 2010;Fugate et al 2010;Akins et al 2010;Nowak et al 2011;Kahle et al 2011).…”