Abstract
The authors report a case of fatal acute encephalopathy following influenza infection, with slightly atypical pathological and imaging findings. A healthy 8-year-old boy with probable recent influenza A/B infection admitted for refractory seizures was placed on phenobarbital coma and later developed hemodynamic instability. Magnetic resonance imaging revealed bilateral cerebral and cerebellar white matter lesions and microhemorrhages. Following his demise, the autopsy revealed a large area of necrosis in the right centrum semiovale with similar lesions in the temporal and cerebellar regions. Microscopically, there was extensive coagulative necrosis, compatible with necrotizing white matter encephalopathy, and neuronal loss suggesting superimposed hypoxic-ischemia. The acute progressive neurologic deterioration was partly reminiscent on acute necrotizing encephalopathy, a condition recently associated with influenza A. In acute necrotizing encephalopathy, typical brain findings are characterized by bilateral thalamic necrosis/petechiae with variable white matter edema. The somewhat atypical findings in our case can relate to superadded cardiovascular collapse and hypoxic-ischemic effects.
References
May 1, 1995·Journal of Neurology, Neurosurgery, and Psychiatry·M MizuguchiS Kamoshita
Apr 11, 2003·Scandinavian Journal of Infectious Diseases·Takashi IchiyamaSusumu Furukawa
Feb 20, 2007·The Journal of Pediatrics·Jason G NewlandSusan E Coffin
May 6, 2008·Brain & Development·Akihisa OkumuraHirokazu Kurahashi
Mar 2, 2010·Journal of Korean Medical Science·Hye-Eun SeoSoonhak Kwon
May 26, 2011·Current Opinion in Pediatrics·Derek E Neilson
May 11, 2012·Korean journal of pediatrics·Yoo-Na Kim, Su Jeong You
May 29, 2012·Pediatric Neurology·Wendy S VargasGail Solomon
Jul 27, 2012·Brain & Development·Brahim TabarkiSaad Al Shahwan
Dec 11, 2013·Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie·C Di MeglioB Chabrol
Dec 20, 2013·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Anu GoenkaRachel Kneen
Apr 22, 2014·Brain & Development·Hussain Imam Muhammad IsmailUNKNOWN National Paediatric H1N1 Study Group
Dec 3, 2014·Pediatric Neurology·Kevin Y WangDoris D M Lin
Dec 20, 2014·European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society·Rahul R SinghMichael Absoud