title: A 7-year-old boy dying of acute encephalopathy.
abstract: A 7 year old Chinese boy died of a rapidly progressive encephalopathy after influenza infection. MRI showed bilateral and symmetrical lesions including the thalamus and brainstem tegmentum. The pathology of necrosis and vasculopathy were in keeping with acute necrotizing encephalopathy (ANE). ANE was first described in Japan and carries a high mortality and morbidity. A vasculopathy with breakdown of the blood-brain-barrier was incriminated but the pathogenesis remained obscure and autopsy studies have been limited. A review of the literature showed only nine postmortem reports in the acute stage. Symmetrical brain necrosis always involved the thalamus followed by the tegmentum of the pons and other regions. Exudative vasculopathy was commonly observed and often accompanied by endothelial cell necrosis. In the present case there was inflammatory fibrinoid vasculitis which has not been previously described.
authors.forename: Wai-Fu
authors.initials: WF
authors.lastname: Ng
authors.forename: Sin-Chuen
authors.initials: SC
authors.lastname: Chiu
authors.forename: David S-Y
authors.initials: DS
authors.lastname: Lam
authors.forename: Yiu-Chung
authors.initials: YC
authors.lastname: Wong
authors.forename: Sidney
authors.initials: S
authors.lastname: Tam
authors.forename: Ngai-Shan
authors.initials: NS
authors.lastname: Kwong
authors.forename: Ka-Tai
authors.initials: KT
authors.lastname: Loo
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D001249:Asthma / Q000150:complications; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D002648:Child; D017809:Fatal Outcome; D015600:Glasgow Coma Scale; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000473:pathology*; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000209:etiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D013788:Thalamus / Q000473:pathology