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Child's Nervous System

, Volume 34, Issue 2, pp 335–347 | Cite as

Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study)

  • Muhammet Sukru PaksuEmail author
  • Kerim Aslan
  • Tanil Kendirli
  • Basak Nur Akyildiz
  • Nazik Yener
  • Riza Dincer Yildizdas
  • Mehmet Davutoglu
  • Ayhan Yaman
  • Sedat Isikay
  • Gulnar Sensoy
  • Haydar Ali Tasdemir
Original Paper

Abstract

Purpose

Although influenza primarily affects the respiratory system, in some cases, it can cause severe neurological complications. Younger children are especially at risk. Pediatric literature is limited on the diagnosis, treatment, and prognosis of influenza-related neurological complications. The aim of the study was to evaluate children who suffered severe neurological manifestation as a result of seasonal influenza infection.

Methods

The medical records of 14 patients from six hospitals in different regions of the country were evaluated. All of the children had a severe neurological manifestations related to laboratory-confirmed influenza infection.

Results

Median age of the patients was 59 months (6 months—15.5 years) and nine (64.3%) were male. Only 4 (28.6%) of the 14 patients had a comorbid disease. Two patients were admitted to hospital with influenza-related late complications, and the remainder had acute complication. The most frequent complaints at admission were fever, altered mental status, vomiting, and seizure, respectively. Cerebrospinal fluid (CSF) analysis was performed in 11 cases, and pleocytosis was found in only two cases. Neuroradiological imaging was performed in 13 patients. The most frequent affected regions of nervous system were as follows: cerebellum, brainstem, thalamus, basal ganglions, periventricular white matter, and spinal cords. Nine (64.3%) patients suffered epileptic seizures. Two patients had focal seizure, and the rest had generalized seizures. Two patients developed status epilepticus. Most frequent diagnoses of patients were encephalopathy (n = 4), encephalitis (n = 3), and meningitis (n = 3), respectively. The rate of recovery without sequelae from was found to be 50%. At discharge, three (21.4%) patients had mild symptoms, another three (21.4%) had severe neurological sequelae. One (7.1%) patient died. The clinical findings were more severe and outcome was worse in patients <5 years old than patients >5 years old and in patients with comorbid disease than previously healthy group.

Conclusion

Seasonal influenza infection may cause severe neurological complications, especially in children. Healthy children are also at risk such as patients with comorbid conditions. All children who are admitted with neurological findings, especially during the influenza season, should be evaluated for influenza-related neurological complications even if their respiratory complaints are mild or nonexistent.

Keywords

Influenza Infection Neurological complication Children 

Notes

Authors’ contributions

Muhammet Sukru Paksu was performed literature search and writing and submitting of the manuscript.

Kerim Aslan was evaluated neuroradiological images of study patients.

Tanil Kendirli was recorded patient medical data of hospital 2 and he edited of manuscript.

Basak Nur Akyildiz was recorded patient medical data of hospital 3 she edited of manuscript.

Nazik Yener was recorded patient medical data of hospital 1 and she searched the literature.

Riza Dincer Yildizdas was recorded patient medical data of hospital 4 and he edited of manuscript.

Mehmet Davutoglu was recorded patient medical data of hospital 5 and he edited of manuscript.

Ayhan Yaman was recorded patient medical data of hospital 6.

Sedat Isikay was recorded patient medical data of hospital 5.

Gulnar Sensoy was edited and approved the final version of the manuscript.

Haydar Ali Tasdemir was edited and approved the final version of the manuscript.

Compliance with ethical standards

Funding

This study was not funded by any institution, organization, or company. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest associated with this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee of Ondokuz Mayis University (Samsun, Turkey).

According to local ethical standards, informed consent is not needed for retrospective study.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Muhammet Sukru Paksu
    • 1
    • 2
    Email author
  • Kerim Aslan
    • 3
  • Tanil Kendirli
    • 4
  • Basak Nur Akyildiz
    • 5
  • Nazik Yener
    • 1
  • Riza Dincer Yildizdas
    • 6
  • Mehmet Davutoglu
    • 7
  • Ayhan Yaman
    • 8
  • Sedat Isikay
    • 9
  • Gulnar Sensoy
    • 10
  • Haydar Ali Tasdemir
    • 11
  1. 1.Pediatric Intensive Care UnitOndokuz Mayis University Faculty of MedicineSamsunTurkey
  2. 2.Ondokuz Mayis Universitesi Tip Fakultesi Cocuk Yogun Bakim UnitesiSamsunTurkey
  3. 3.Department of RadiologyOndokuz Mayis University Faculty of MedicineSamsunTurkey
  4. 4.Pediatric Intensive Care UnitAnkara University Faculty of MedicineAnkaraTurkey
  5. 5.Pediatric Intensive Care UnitErciyes University Faculty of MedicineKayseriTurkey
  6. 6.Pediatric Intensive Care UnitCukurova University Faculty of MedicineAdanaTurkey
  7. 7.Pediatric Intensive Care UnitSutcu Imam University Faculty of MedicineKahramanmarasTurkey
  8. 8.Pediatric Intensive Care UnitObstetrics and Gynecology and Children’s HospitalGaziantepTurkey
  9. 9.Pediatric NeurologySutcu Imam University Faculty of MedicineKahramanmarasTurkey
  10. 10.Department of Pediatric Infection DiseasesOndokuz Mayis University Faculty of MedicineSamsunTurkey
  11. 11.Department of Pediatric NeurologyOndokuz Mayis University Faculty of MedicineSamsunTurkey

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