title: Differential diagnosis of delirious behavior in children with influenza.
abstract: Delirious behavior (DB) in children infected with influenza virus is an important symptom associated with encephalopathy. As children with influenza-associated DB with encephalopathy may require therapy whereas children with influenza-associated DB without encephalopathy do not, distinguishing between these conditions is essential. To clarify these differences and identify the most common features of acute encephalopathy, we retrospectively reviewed the clinical course, laboratory data, magnetic resonance imaging (MRI) and electroencephalography (EEG) findings, therapy, and prognosis of 48 children with influenza exhibiting DB. Of the 48 children, 37 and 11 were diagnosed with influenza A and B, respectively. Moreover, 40 were diagnosed with DB without encephalopathy (DBNE group) and 8, with DB with encephalopathy (DBE group). Reversible splenial lesion (RESLE) was detected in 7 patients in the DBNE group, mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in 2 patients, and a mild form of acute encephalopathy with biphasic seizures and late reduced diffusion in 1 patient in the DBE group. Serum sodium levels <136mEq/L were observed in 28 cases. Disturbance of consciousness was observed in 25 cases, seizure in 20, and slow waves on EEG in 22. Methylprednisolone pulse therapy was administered in 8 cases. No cases of neurological sequelae were observed. Although most of the clinico-radiological features of the DBNE and DBE groups did not differ substantially, marked differences were observed in the age at onset, initial neurological symptoms, duration of DB, rate of seizure, and slowing of background activity on EEG. These differences should be considered when distinguishing between DBNE and DBE in children.
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan. Electronic address: dbs003@art.osaka-med.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kashiwagi
authors.affiliation: Department of Child Neurology, Tanabe Children's Clinic, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Tanabe
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Chizu
authors.initials: C
authors.lastname: Ooba
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Shigehara
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Murata
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ashida
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Shirasu
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okasora
authors.affiliation: Department of Pediatrics, Osaka Medical College, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamai
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003693:Delirium / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: Age; Delirious behavior; Differential diagnosis; Disturbance of consciousness; Encephalopathy; Influenza; Reversible splenial lesion during febrile illness; Seizure