title: Outcome in patients with H1N1 influenza and cerebrovascular injury treated with extracorporeal membrane oxygenation.
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.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center, Suite 835, Boston, MA. 02114, USA. fcchow@partners.org
authors.forename: Felicia C
authors.initials: FC
authors.lastname: Chow
authors.forename: Brian L
authors.initials: BL
authors.lastname: Edlow
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Frosch
authors.forename: William A
authors.initials: WA
authors.lastname: Copen
authors.forename: David M
authors.initials: DM
authors.lastname: Greer
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D055815:Young Adult