title: Acute necrotising encephalopathy in a child with H1N1 influenza infection: a clinicoradiological diagnosis and follow-up.
abstract: Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressive encephalopathy, seizures and poor outcome. It has been reported in association with various viral infections. We describe the clinicoradiological findings and short-term follow-up in a child with H1N1 influenza-associated ANEC. Laminar, target or tricolour pattern of involvement of the thalami was seen on apparent diffusion coefficient images. Our patient had significant morbidity at discharge despite early diagnosis and management with oseltamivir and immunoglobulin. Repeat imaging after 3 months had shown significant resolution of thalamic swelling, but there was persistence of cytotoxic oedema involving bilateral thalami. She was pulsed with intravenous steroids and maintained on a tapering schedule of oral steroids. This report emphasises the need for a high index of suspicion to establish early diagnosis, promotion of widespread immunisation strategies to prevent influenza outbreak, and more research to establish standard treatment protocols for this under-recognised entity.
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Yoganathan
authors.affiliation: Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sniya Valsa
authors.initials: SV
authors.lastname: Sudhakar
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Ebor Jacob
authors.initials: EJ
authors.lastname: James
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Maya Mary
authors.initials: MM
authors.lastname: Thomas
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D053139:Oseltamivir / Q000627:therapeutic use; D013788:Thalamus / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D053139:Oseltamivir