Varying Patterns of CNS Imaging in Influenza A Encephalopathy in Childhood

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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References

  1. 1.

    Ekstrand JJ, Herbener A, Rawlings J, Turney B, Ampofo K, Korgenski EK, Bonkowsky JL. Heightened neurologic complications in children with pandemic H1N1 influenza. Ann Neurol. 2010;68:762–6.

    Article  Google Scholar 

  2. 2.

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

    CAS  Article  Google Scholar 

  3. 3.

    Porto L, Lanfermann H, Möller-Hartmann W, Jacobi G, Zanella F. Acute necrotising encephalopathy of childhood after exanthema subitum outside Japan or Taiwan. Neuroradiology. 1999;41:732–4.

    CAS  Article  Google Scholar 

  4. 4.

    Wong AM, Simon EM, Zimmerman RA, Wang HS, Toh CH, Ng SH. Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome. AJNR Am J Neuroradiol. 2006;27:1919–23.

    CAS  Google Scholar 

  5. 5.

    Ishida Y, Kawashima H, Morichi S, Yamanaka G, Okumura A, Nakagawa S, Morishima T. Brain magnetic resonance imaging in acute phase of pandemic influenza A (H1N1) 2009-associated encephalopathy in children. Neuropediatrics. 2015;46:20–5.

    Google Scholar 

  6. 6.

    Ka A, Britton P, Troedson C, Webster R, Procopis P, Ging J, Chua YW, Buckmaster A, Wood N, Jones C, Dale RC. Mild encephalopathy with reversible splenial lesion: an important differential of encephalitis. Eur J Paediatr Neurol. 2015;19:377–82.

    Article  Google Scholar 

  7. 7.

    Bulakbasi N, Kocaoglu M, Tayfun C, Ucoz T. Transient splenial lesion of the corpus callosum in clinically mild influenza-associated encephalitis/encephalopathy. AJNR Am J Neuroradiol. 2006;27:1983–6.

    CAS  Google Scholar 

  8. 8.

    Kim JH, Kim IO, Lim MK, Park MS, Choi CG, Kim HW, Kim JE, Choi SJ, Koh YH, Yang DM, Choo SW, Chung MJ, Yoon HK, Goo HW, Lee M. Acute necrotizing encephalopathy in Korean infants and children: imaging findings and diverse clinical outcome. Korean J Radiol. 2004;5:171–7.

    Article  Google Scholar 

  9. 9.

    Yoshikawa H, Yamazaki S, Watanabe T, Abe T. Study of influenza-associated encephalitis/encephalopathy in children during the 1997 to 2001 influenza seasons. J Child Neurol. 2001;16:885–90.

    CAS  Article  Google Scholar 

  10. 10.

    Neilson DE, Adams MD, Orr CM, Schelling DK, Eiben RM, Kerr DS, Anderson J, Bassuk AG, Bye AM, Childs AM, Clarke A, Crow YJ, Di Rocco M, Dohna-Schwake C, Dueckers G, Fasano AE, Gika AD, Gionnis D, Gorman MP, Grattan-Smith PJ, Hackenberg A, Kuster A, Lentschig MG, Lopez-Laso E, Marco EJ, Mastroyianni S, Perrier J, Schmitt-Mechelke T, Servidei S, Skardoutsou A, Uldall P, van der Knaap MS, Goglin KC, Tefft DL, Aubin C, de Jager P, Hafler D, Warman ML. Infection-triggered familial or recurrent cases of acute necrotizing encephalopathy caused by mutations in a component of the nuclear pore, RANBP2. Am J Hum Genet. 2009;84:44–51.

    CAS  Article  Google Scholar 

  11. 11.

    Zeng H, Quinet S, Huang W, Gan Y, Han C, He Y, Wang Y. Clinical and MRI features of neurological complications after influenza A (H1N1) infection in critically ill children. Pediatr Radiol. 2013;43:1182–9.

    Article  Google Scholar 

  12. 12.

    Xiujuan W, Wei W, Wei P, Limin W, Kangding L, Hong-Liang Z. Acute necrotizing encephalopathy: an underrecognized clinicoradiologic disorder. Mediators Inflamm. 2015; https://doi.org/10.1155/2015/792578.

    Article  Google Scholar 

  13. 13.

    Albayram S, Bilgi Z, Selcuk H, Selcuk D, Cam H, Koçer N, Islak C. Diffusion-weighted MR imaging findings of acute necrotizing encephalopathy. AJNR Am J Neuroradiol. 2004;25:792–7.

    Google Scholar 

  14. 14.

    Chow FC, Edlow BL, Frosch MP, Copen WA, Greer DM. Outcome in patients with H1N1 influenza and cerebrovascular injury treated with extracorporeal membrane oxygenation. Neurocrit Care. 2011;15:156–60.

    Article  Google Scholar 

  15. 15.

    Takanashi J, Barkovich AJ, Yamaguchi K, Kohno Y. Influenza-associated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. AJNR Am J Neuroradiol. 2004;25:798–802.

    Google Scholar 

  16. 16.

    Takanashi J. Two newly proposed infectious encephalitis/encephalopathy syndromes. Brain Dev. 2009;31:521–8.

    Article  Google Scholar 

  17. 17.

    Takanashi J, Tada H, Maeda M, Suzuki M, Terada H, Barkovich AJ. Encephalopathy with a reversible splenial lesion is associated with hyponatremia. Brain Dev. 2009;31:217–20.

    Article  Google Scholar 

  18. 18.

    Chen WX, Liu HS, Yang SD, Zeng SH, Gao YY, Du ZH, Li XJ, Lin HS, Liang HC, Mai JN. Reversible splenial lesion syndrome in children: retrospective study and summary of case series. Brain Dev. 2016;38:915–27.

    Article  Google Scholar 

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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

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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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Keywords

  • Acute necrotizing encephalitis of childhood
  • Mild encephalopathy with a reversible splenial lesion
  • Atypical hemorrhage