Neuropediatrics 2015; 46(01): 020-025
DOI: 10.1055/s-0034-1393708
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Brain Magnetic Resonance Imaging in Acute Phase of Pandemic Influenza A (H1N1) 2009–Associated Encephalopathy in Children

Yu Ishida
1   Department of Pediatrics, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
,
Hisashi Kawashima
1   Department of Pediatrics, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
,
Shinichiro Morichi
1   Department of Pediatrics, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
,
Gaku Yamanaka
1   Department of Pediatrics, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
,
Akihisa Okumura
2   Department of Pediatrics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Satoshi Nakagawa
3   Department of Intensive Care, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
,
Tsuneo Morishima
4   Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
› Author Affiliations
Further Information

Publication History

06 December 2013

04 August 2014

Publication Date:
07 October 2014 (online)

Abstract

Pandemic influenza A (H1N1) 2009 has been shown to be associated more with neurological complications than the seasonal influenza virus. In this study, we focused on the clinical usefulness of magnetic resonance imaging (MRI) in the acute phase of influenza A (H1N1) 2009–associated encephalopathy. A questionnaire was distributed to pediatric and general hospitals in Japan that treat children with encephalopathy. We conducted a questionnaire-based study involving the collection of information regarding 207 patients with encephalopathy. Brain MRI was performed in 97 of these 207 patients in the age group of 9 months to 15 years (mean, 7.5 years) within 48 hours after the development of encephalopathy symptoms. Sixty-six patients (68%) showed normal imaging. Diffuse brain edema was visible in five patients and an abnormal signal in the deep gray matter in two patients which is consistent with acute necrotizing encephalopathy. Abnormal signals of the splenial lesion, subcortical white matter (bright tree appearance), and cortical area were observed in 15, 1, and 8 patients, respectively. From our findings based on the questionnaire results, we suggest that MRI is useful for determining fatal cases of pandemic influenza A (H1N1) 2009 infection when performed in the acute phase. However, MRI is not useful in predicting the development of sequelae.

 
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