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Varying Patterns of CNS Imaging in Influenza A Encephalopathy in Childhood

  • Mete DadakEmail author
  • Refik Pul
  • Heinrich Lanfermann
  • Hans Hartmann
  • Ute Hehr
  • Frank Donnerstag
  • Dirk Michels
  • Anita Blanka Tryc
Original Article
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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.

Keywords

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

Notes

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mete Dadak
    • 1
    Email author
  • Refik Pul
    • 2
  • Heinrich Lanfermann
    • 1
  • Hans Hartmann
    • 3
  • Ute Hehr
    • 4
  • Frank Donnerstag
    • 1
  • Dirk Michels
    • 5
  • Anita Blanka Tryc
    • 6
  1. 1.Department of NeuroradiologyHannover Medical SchoolHannoverGermany
  2. 2.Clinic for NeurologyUniversity Hospital EssenEssenGermany
  3. 3.Clinic for Pediatric Kidney, Liver and Metabolic DisordersHannover Medical SchoolHannoverGermany
  4. 4.Institute of Human GeneticsUniversity of RegensburgRegensburgGermany
  5. 5.Department of Radiology and NeuroradiologyKlinikum NordstadtHannoverGermany
  6. 6.Clinic for NeurologyHannover Medical SchoolHannoverGermany

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