Paksu Muhammet Sukru, Aslan Kerim, Kendirli Tanil, Akyildiz Basak Nur, Yener Nazik, Yildizdas Riza Dincer, Davutoglu Mehmet, Yaman Ayhan, Isikay Sedat, Sensoy Gulnar, Tasdemir Haydar Ali
Pediatric Intensive Care Unit, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
Ondokuz Mayis Universitesi Tip Fakultesi Cocuk Yogun Bakim Unitesi, 55139, Samsun, Turkey.
Childs Nerv Syst. 2018 Feb;34(2):335-347. doi: 10.1007/s00381-017-3554-3. Epub 2017 Jul 31.
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.
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.
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.
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.
虽然流感主要影响呼吸系统，但在某些情况下，它可导致严重的神经系统并发症。年幼儿童尤其危险。儿科文献中关于流感相关神经系统并发症的诊断、治疗和预后的内容有限。本研究的目的是评估因季节性流感感染而出现严重神经系统表现的儿童。
对来自该国不同地区六家医院的14例患者的病历进行评估。所有儿童均有与实验室确诊的流感感染相关的严重神经系统表现。
患者的中位年龄为59个月（6个月至15.5岁），9例（64.3%）为男性。14例患者中只有4例（28.6%）有合并症。2例患者因流感相关的晚期并发症入院，其余患者有急性并发症。入院时最常见的主诉分别是发热、精神状态改变、呕吐和癫痫发作。11例患者进行了脑脊液（CSF）分析，仅2例发现有细胞增多。13例患者进行了神经影像学检查。神经系统最常受累的区域如下：小脑、脑干、丘脑、基底节、脑室周围白质和脊髓。9例（64.3%）患者发生癫痫发作。2例患者有局灶性发作，其余患者有全身性发作。2例患者发展为癫痫持续状态。患者最常见的诊断分别是脑病（n = 4）、脑炎（n = 3）和脑膜炎（n = 3）。发现无后遗症恢复的比例为50%。出院时，3例（21.4%）患者有轻微症状，另外3例（21.4%）有严重神经系统后遗症。1例（7.1%）患者死亡。<5岁的患者比>5岁的患者以及有合并症的患者比以前健康的组临床症状更严重，预后更差。
季节性流感感染可能导致严重的神经系统并发症，尤其是在儿童中。健康儿童以及有合并症的患者也有风险。所有因神经系统表现入院的儿童，尤其是在流感季节，即使其呼吸道症状轻微或不存在，也应评估是否有流感相关的神经系统并发症。
