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Outcome in Patients with H1N1 Influenza and Cerebrovascular Injury Treated with Extracorporeal Membrane Oxygenation

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Abstract

Background

Although intracranial hemorrhage and infarction have been reported in patients with H1N1 influenza infection treated with extracorporeal membrane oxygenation (ECMO), the clinical outcomes of these patients are not well described.

Methods

The authors present two patients with H1N1 influenza infection and diffuse cerebrovascular injury in the setting of ECMO.

Results

Diffuse cerebrovascular injury including intraparenchymal hemorrhage was found on head CT and brain MRI in both cases and confirmed by autopsy in one patient who died. Punctate foci of susceptibility effect were seen in both patients on T2* susceptibility-weighted or susceptibility-sensitive gradient echo sequences. These foci of susceptibility effect were consistent with infarction on histopathologic evaluation in the patient who died. The other patient made an excellent clinical recovery.

Conclusions

Frequent and early surveillance imaging should be obtained in patients with H1N1 influenza infection undergoing ECMO, although the presence of diffuse cerebral injury, including intraparenchymal hemorrhage and multifocal punctate susceptibility effect, does not necessarily portend a poor prognosis.

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Authors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center, Suite 835, Boston, MA, 02114, USA

    Felicia C. Chow & Brian L. Edlow

  2. Harvard University, Boston, MA, USA

    Felicia C. Chow, Brian L. Edlow, Matthew P. Frosch & William A. Copen

  3. Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA

    William A. Copen

  4. C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, MA, USA

    Matthew P. Frosch

  5. Department of Neurology, Yale-New Haven Hospital, New Haven, CT, USA

    David M. Greer

  6. Yale University School of Medicine, New Haven, CT, USA

    David M. Greer

  7. Department of Neurology, Stroke Service, Massachusetts General Hospital, Boston, MA, USA

    David M. Greer

Authors
  1. Felicia C. Chow
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  2. Brian L. Edlow
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  3. Matthew P. Frosch
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  4. William A. Copen
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  5. David M. Greer
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Corresponding author

Correspondence to Felicia C. Chow.

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Chow, F.C., Edlow, B.L., Frosch, M.P. et al. Outcome in Patients with H1N1 Influenza and Cerebrovascular Injury Treated with Extracorporeal Membrane Oxygenation. Neurocrit Care 15, 156–160 (2011). https://doi.org/10.1007/s12028-011-9534-7

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  • DOI: https://doi.org/10.1007/s12028-011-9534-7

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