Influenza A(H1N1)-associated ischemic stroke in a 9-month-old child.

AIM

This study aimed to report a rare clinical course of pandemic influenza A(H1N1) infection, ischemic stroke, in a 9 month-old child.

CASE

A 9-month-old girl with no previous medical problem presented to our pediatric emergency department with high fever (39°C/102°F) lasting for 48 hours. Soon after admission, she started generalized tonic-clonic seizures that ceased after 2 injections of diazepam. Six hours later, she presented 2 short episodes of partial clonic seizures of the right arm followed by monoplegia. Lumbar puncture was normal. Noncontrast computed tomographic imaging of the brain was performed and revealed an acute infarct in the left middle cerebral artery territory with no mass effect. Electroencephalogram revealed important slowing in the left hemisphere. A magnetic resonance imaging was performed the next day and confirmed an ischemic stroke in the left posterior middle cerebral artery region. Nasal swab polymerase chain reaction was positive for influenza A(H1N1) and polymerase chain reaction detection negative in cerebrospinal fluid. She fully recovered her right-arm function on day 3 and was discharged on day 10 without sequelae.

COMMENTS

Seasonal influenza is known to cause neurological complications in children. Influenza increases the stroke risk especially in adults at high risk. This is a rare event in childhood, and we believe this is the first report associated with H1N1 new variant.

CONCLUSIONS

Acute viral infection, notably influenza, is associated with increased susceptibility to stroke, and vaccination against influenza may reduce the risk of stroke.