nach oben

Pediatric Radiology

Erschienen in:

01.09.2013 | Original Article

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

verfasst von: Hongwu Zeng, Stephen Quinet, Wenxian Huang, Yungen Gan, Chunxi Han, Yanxia He, Yonker Wang

Erschienen in: Pediatric Radiology | Ausgabe 9/2013

Einloggen, um Zugang zu erhalten

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.

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

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

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

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

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 31:396–400PubMedCrossRef

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

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

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

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 54:167–172PubMedCrossRef

10.

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

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 27:1919–1923PubMed

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 5:171–177PubMedCrossRef

13.

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

14.

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

15.

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

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 58:555–561PubMedCrossRef

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 16:439–447PubMed

18.

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

19.

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

20.

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

21.

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

22.

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

23.

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

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 5:199–202PubMedCrossRef

25.

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

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:e121PubMedCrossRef

27.

Takanashi J, Takahashi Y, Imamura A et al (2012) Late delirious behavior with 2009 H1N1 influenza: mild autoimmune-mediated encephalitis? Pediatrics 129:e1068–e1071PubMedCrossRef

28.

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

29.

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

30.

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

Titel: Clinical and MRI features of neurological complications after influenza A (H1N1) infection in critically ill children
verfasst von: Hongwu Zeng
Stephen Quinet
Wenxian Huang
Yungen Gan
Chunxi Han
Yanxia He
Yonker Wang
Publikationsdatum: 01.09.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Radiology / Ausgabe 9/2013
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-013-2682-5

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

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

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Neu im Fachgebiet Radiologie

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Update Radiologie

Springer Medizin

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2013

Disorders of midgut rotation: making the correct diagnosis on UGI series in difficult cases

Fetal MRI on a multi-element digital coil platform

Hermes

Lung tattooing combined with immediate video-assisted thoracoscopic resection (IVATR) as a single procedure in a hybrid room: our institutional experience in a pediatric population

Congenital lung lesions: prenatal MRI and postnatal findings

Size-appropriate radiation doses in pediatric body CT: a study of regional community adoption in the United States

Neu im Fachgebiet Radiologie

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Update Radiologie