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Varying Patterns of CNS Imaging in Influenza A Encephalopathy in Childhood

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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.

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Authors and Affiliations

  1. Department of Neuroradiology, Hannover Medical School, Carl-Neuberg-Str-1, 30625, Hannover, Germany

    Mete Dadak, Heinrich Lanfermann & Frank Donnerstag

  2. Clinic for Neurology, University Hospital Essen, Essen, Germany

    Refik Pul

  3. Clinic for Pediatric Kidney, Liver and Metabolic Disorders, Hannover Medical School, Hannover, Germany

    Hans Hartmann

  4. Institute of Human Genetics, University of Regensburg, Regensburg, Germany

    Ute Hehr

  5. Department of Radiology and Neuroradiology, Klinikum Nordstadt, Hannover, Germany

    Dirk Michels

  6. Clinic for Neurology, Hannover Medical School, Hannover, Germany

    Anita Blanka Tryc

Authors
  1. Mete Dadak
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  2. Refik Pul
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  3. Heinrich Lanfermann
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  4. Hans Hartmann
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  5. Ute Hehr
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  6. Frank Donnerstag
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  7. Dirk Michels
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  8. Anita Blanka Tryc
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Corresponding author

Correspondence to Mete Dadak.

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Conflict of interest

M. Dadak, R. Pul, H. Lanfermann, H. Hartmann, U. Hehr, F. Donnerstag, D. Michels and A.B. Tryc declare that they have no competing interests

Additional information

The authors M. Dadak and R. Pul contributed equally to the manuscript.

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Dadak, M., Pul, R., Lanfermann, H. et al. Varying Patterns of CNS Imaging in Influenza A Encephalopathy in Childhood. Clin Neuroradiol 30, 243–249 (2020). https://doi.org/10.1007/s00062-018-0756-3

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  • DOI: https://doi.org/10.1007/s00062-018-0756-3

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