J Child Neurol. 2010 Dec;25(12):1539-41. Epub 2010 Sep 7.
Acute necrotizing encephalopathy of childhood with spinal cord involvement: a case report.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan. leeped@hotmail.com
Abstract
Acute necrotizing encephalopathy of childhood is a rare acute encephalopathy occurring after febrile illness with subsequent rapid deterioration of consciousness and convulsions. Typical brain magnetic resonance imaging (MRI) findings are symmetric involvement of the bilateral thalami, brainstem, and cerebral periventricular white matter or the cerebellum. Spinal cord involvement has never been reported. This report describes a healthy 2-year-old girl, who displayed typical clinical manifestations of acute necrotizing encephalopathy. Brain MRI demonstrated symmetrical lesions over the bilateral thalami and periventricular white matter. The clinical features and radiologic images suggested spinal cord involvement. This is the first reported case of acute necrotizing encephalopathy with spinal cord involvement. Spinal cord lesions are, therefore, possible in cases of acute necrotizing encephalopathy of childhood, and these require special attention.
PMID: 20823028 [PubMed - in process]
AJNR Am J Neuroradiol. 2010 Mar;31(3):396-400.
Acute necrotizing encephalopathy in a child during the 2009 influenza A(H1N1) pandemia: MR imaging in diagnosis and follow-up.
Department of Diagnostic Neuroradiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. formitti@ao.pr.it
Comment in: Abstract
The recently emerged novel influenza A(H1N1) virus continues to spread globally. The clinical disease generally appears mild, but unfavorable outcomes have been reported. We describe a case of a 3-year-old Italian girl infected with influenza A(H1N1) virus presenting with neurologic deterioration. CT findings were negative, but MR imaging findings were consistent with ANE. To our knowledge, this is the first case reported in Europe and the second in worldwide pediatric radiology literature.PMID: 20231352 [PubMed - indexed for MEDLINE]
Pediatr Infect Dis J. 2004 Mar;23(3):253-4.
The puzzling picture of acute necrotizing encephalopathy after influenza A and B virus infection in young children.
Virology Laboratory, Childrens Hospital of Iowa, Iowa City, IA, USA.
Abstract
Acute necrotizing encephalopathy is a complication of influenza A and B virus infection in young children, especially in Japan. The disease is characterized by high fever, convulsions and coma. A prominent feature of this central nervous system disease is bilateral thalamic necrosis, documented by magnetic resonance imaging. The pathogenesis of the virus-associated brain pathology has not yet been elucidated. There is considerable circumstantial evidence that influenza immunization may decrease the likelihood of children developing acute necrotizing encephalopathy.Imaging in influenza A encephalitis.
Department of Paediatrics, University Hospital, Nottingham.
Abstract
Two cases of influenza A encephalitis seen during an outbreak of influenza types A/England/427/88 (H3N2) and A/Taiwan/1/86 (H1N1) in December 1989 are described. In both children the encephalitis developed within three days of the respiratory symptoms and both became comatose within 48 hours. Virological studies showed that the patients had had a recent influenza A infection. Symmetrical localised hypodense lesions within the thalami and pons were demonstrated in both cases on computed tomography of the brain and striking findings in the pons in one case on magnetic resonance imaging. Influenza A encephalitis is not easy to recognise clinically and serological confirmation can only be made after 10 days. Imaging may provide evidence in the acute stage to support a diagnosis of influenza encephalitis during influenza outbreaks.Pediatr Neurol. 2010 Jun;42(6):447-50.
Reversible splenial lesion associated with novel influenza A (H1N1) viral infection.
Department of Pediatrics, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-Ku, Kobe 651-2273, Japan. lisa-gaspard@hi-net.zaq.ne.jp
Abstract
We describe clinically mild encephalopathy with a reversible lesion in the splenium of the corpus callosum associated with the novel swine-origin influenza A (H1N1) virus. A 14-year-old Japanese boy was hospitalized because of dysarthria and dysphagia 5 days after the onset of fever. He had been receiving zanamivir for 4 days before admission. Diffusion-weighted magnetic resonance imaging on clinical day 6 revealed lesions in the splenium of the corpus callosum and bilateral frontoparietal white matter. With continued zanamivir treatment, his signs completely resolved within 24 hours, and the abnormal radiologic signals resolved 3 days later. Neurologic signs were limited to pseudobulbar palsy, without impairment of consciousness or seizures. This presentation is, to our knowledge, the first among patients with mild encephalopathy with a reversible lesion in the splenium of the corpus callosum, expanding the clinical spectrum of this condition. Our findings indicate that pandemic 2009 influenza A (H1N1) infection can cause mild encephalopathy with a reversible lesion in the splenium of the corpus callosum.
Copyright 2010 Elsevier Inc. All rights reserved.PMID: 20472201 [PubMed - indexed for MEDLINE]
AJNR Am J Neuroradiol. 2010 Sep;31(8):1443-6. Epub 2009 Dec 24.
Influenza A encephalopathy, cerebral vasculopathy, and posterior reversible encephalopathy syndrome: combined occurrence in a 3-year-old child.
Department of Radiology, Presbyterian University Hospital, University of Pittsburgh, Pittsburgh, PA, USA. bartynskiws@upmc.edu
Abstract
Encephalopathy is an uncommon complication of childhood influenza infection, typically recognized during influenza epidemics. Imaging hallmarks include characteristic thalamic lesions, thalamic necrosis and hemispheric edema. We describe a child with acute influenza A associated necrotizing encephalopathy with MR angiographic evidence of significant cerebral vasculopathy and a hemispheric edema pattern consistent with PRES. This case reinforces that significant cerebral vasculopathy can accompany influenza infection and that influenza is a likely trigger for PRES.
PMID: 20037134 [PubMed - indexed for MEDLINE]
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