Department of Radiology, Shenzhen Children's Hospital, Guangdong, China.
Pediatr Radiol. 2013 Sep;43(9):1182-9. doi: 10.1007/s00247-013-2682-5. Epub 2013 Apr 9.
Influenza A (H1N1) can cause severe neurological complications.
The purpose of this study was to analyze clinical and MRI features of neurological complications after H1N1 infection in critically ill children.
We retrospectively analyzed clinical and neuroimaging findings in 17 children who were hospitalized in an intensive care unit with severe neurological complications after H1N1 infection in South China between September 2009 and December 2011. All children underwent pre- and post-contrast-enhanced brain MRI. Postmortem studies were performed in two children.
Six children died, five because of acute necrotizing encephalopathy (ANE) and one because of intracranial fungal infection. Eleven recovered; their manifestations of H1N1 were meningitis (3), encephalitis (1) and influenza encephalopathy (7). MRI features of ANE included multiple symmetrical brain lesions demonstrating prolonged T1 and T2 signal in the thalami, internal capsule, lenticular nucleus and pontine tegmentum. Postmortem MRI in two children with acute necrotizing encephalopathy showed diffuse prolonged T1 and T2 signal in the bilateral thalami, brainstem deformation and tonsillar herniation.
Fatal neurological complications in children after H1N1 infection include ANE and opportunistic fungal infection. MRI is essential for identification of neurological complications and for clinical evaluation.
甲型 H1N1 流感可引起严重的神经系统并发症。
本研究旨在分析重症患儿感染 H1N1 后发生的神经系统并发症的临床和 MRI 特征。
我们回顾性分析了 2009 年 9 月至 2011 年 12 月期间在中国南方重症监护病房中因 H1N1 感染而出现严重神经系统并发症的 17 例患儿的临床和神经影像学资料。所有患儿均进行了增强前后脑 MRI 检查。对 2 例患儿进行了尸检研究。
6 例患儿死亡，其中 5 例因急性坏死性脑病（ANE），1 例因颅内真菌感染。11 例患儿康复；他们的 H1N1 表现为脑膜炎（3 例）、脑炎（1 例）和流感脑病（7 例）。ANE 的 MRI 特征包括丘脑、内囊、豆状核和脑桥被盖多个对称的脑病变，表现为 T1 和 T2 信号延长。2 例急性坏死性脑病患儿的尸检 MRI 显示双侧丘脑弥散性 T1 和 T2 信号延长，脑干变形和小脑扁桃体疝。
儿童感染 H1N1 后的致命性神经系统并发症包括 ANE 和机会性真菌感染。MRI 对于识别神经系统并发症和临床评估至关重要。
