ABSTRACT
PURPOSE: The brain imaging findings in children with neurological complications associated with influenza A infections are presented and analyzed and pathological imaging changes including atypical intracerebral hemorrhages in these patients are discussed. METHODS: Neuroimaging findings in six children with influenza encephalopathy following influenza A infection between 2012-2017 were retrospectively investigated. Of these five underwent magnetic resonance imaging (MRI) and one computed tomography (CT). Gene analysis was performed in two cases with acute necrotizing encephalitis of childhood (ANEC). RESULTS: The MRI findings of one child were concordant with mild encephalopathy with a reversible splenial lesion (MERS); this patient recovered but remained aphasic. In two cases MRI showed typical bilateral thalamic lesions as a feature of ANEC; genetic testing facilitated the diagnosis in one case. One of the patients died, the other showed little improvement. The remaining three patients had multiple diffuse cerebral hemorrhages predominantly affecting the supratentorial white matter after influenza A infection complicated by pneumonia, rhabdomyolysis and sepsis requiring extracorporeal membrane oxygenation (ECMO). CONCLUSION: Neurological complications in children associated with influenza A infection may include MERS and ANEC. Additionally, atypical disseminated intracerebral hemorrhages as a complication of influenza A infection is reported.
Subject(s)
Brain Diseases/complications , Brain Diseases/diagnostic imaging , Influenza, Human/complications , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Adolescent , Brain/diagnostic imaging , Brain/pathology , Brain Diseases/pathology , Child, Preschool , Female , Humans , Infant , Influenza, Human/pathology , Male , Retrospective StudiesABSTRACT
Estudo retrospectivo de dois casos de hemorragia craniana de localização atípica em 777 recém-natos internados na unidade de terapia intensiva neonatal da Casa de Saúde São José, Rio de Janeiro, RJ. Foram avaliados os aspectos clínicos e o diagnóstico por métodos de imagem. Verificamos que a ultrassonografia foi diagnóstica nos dois casos quando comparada com a ressonância magnética. Em relação à etiologia, esta foi multifatorial, e a manifestação clínica silenciosa independente da localização. Até o presente momento, a avaliação neurológica tem tido curso satisfatório, embora os pacientes ainda tenham baixa idade para a avaliação neurológica definitiva.
Retrospective study of two cases of atypically localized cerebral hemorrhage among 777 newborns admitted to the neonatal intensive care unit at Casa de Saúde São José, Rio de Janeiro, RJ, Brazil. Clinical findings and imaging diagnoses were evaluated. The diagnostic effectiveness of ultrasonography was established by correlation with magnetic resonance imaging findings. Multifactorial etiology was observed, besides silent clinical presentation independently from localization. So far the neurological evaluation has satisfactorily progressed although the patients are still too young to allow a definite neurological evaluation.
