Unusual posterior reversible encephalopathy syndrome in a case of influenza A/H1N1 infection

Nicoletta Locuratolo, Daniela Mannarelli, Claudio Colonnese, Caterina Pauletti, Laura Antonaci, Giancarlo Ferretti, Francesco Fattapposta

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Central nervous system involvement is an uncommon though potentially a severe complication during influenza infection; the pathogenic mechanisms of the neurological syndromes described in humans are largely unknown. We describe a case of a 51-year-old man who presented with fever and behavioral changes but no focal neurological deficits. The next day, the condition rapidly evolved into a severe neurological syndrome with recurrent focal motor seizures with secondary generalization. At the brain MRI, FLAIR disclosed a slight area of increased signal in the left mesial frontal cortex extending to the frontopolar area and insula. At DWI, a mild hyperintensity was evident in the mesial-frontopolar cortex, with normal ADC values. MR perfusion was indicative of severe hypoperfusion. Fungal, bacterial and viral cultures in CSF, blood and urine were negative. The nasopharyngeal swab PCR was positive for the H1N1-influenza A virus. The patient was thus treated and by day five the neurological examination results had returned to normal. A follow-up MRI, performed two weeks later, only revealed a residual slight hyperintensity in the left medial frontal cortex. The onset of a rapidly evolving encephalopathy syndrome, its close association with a MRI brain pattern of acute vasogenic edema and favorable outcome support a diagnosis of PRES during influenza A infection. However, the topographic characteristics of the cerebral lesion seem to define a PRES with an atypical pattern.

Original languageEnglish
Pages (from-to)114-116
Number of pages3
JournalJournal of the Neurological Sciences
Volume321
Issue number1-2
DOIs
Publication statusPublished - Oct 15 2012

Fingerprint

Posterior Leukoencephalopathy Syndrome
Human Influenza
Frontal Lobe
Seizures
Infection
Influenza A virus
Neurologic Examination
Brain
Brain Diseases
Edema
Reference Values
Fever
Central Nervous System
Perfusion
Urine
Polymerase Chain Reaction

Keywords

  • Clinical neurology
  • DWI
  • Encephalopathy
  • Influenza
  • PRES
  • Viral infections

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Locuratolo, N., Mannarelli, D., Colonnese, C., Pauletti, C., Antonaci, L., Ferretti, G., & Fattapposta, F. (2012). Unusual posterior reversible encephalopathy syndrome in a case of influenza A/H1N1 infection. Journal of the Neurological Sciences, 321(1-2), 114-116. https://doi.org/10.1016/j.jns.2012.07.063

Unusual posterior reversible encephalopathy syndrome in a case of influenza A/H1N1 infection. / Locuratolo, Nicoletta; Mannarelli, Daniela; Colonnese, Claudio; Pauletti, Caterina; Antonaci, Laura; Ferretti, Giancarlo; Fattapposta, Francesco.

In: Journal of the Neurological Sciences, Vol. 321, No. 1-2, 15.10.2012, p. 114-116.

Research output: Contribution to journalArticle

Locuratolo, N, Mannarelli, D, Colonnese, C, Pauletti, C, Antonaci, L, Ferretti, G & Fattapposta, F 2012, 'Unusual posterior reversible encephalopathy syndrome in a case of influenza A/H1N1 infection', Journal of the Neurological Sciences, vol. 321, no. 1-2, pp. 114-116. https://doi.org/10.1016/j.jns.2012.07.063
Locuratolo, Nicoletta ; Mannarelli, Daniela ; Colonnese, Claudio ; Pauletti, Caterina ; Antonaci, Laura ; Ferretti, Giancarlo ; Fattapposta, Francesco. / Unusual posterior reversible encephalopathy syndrome in a case of influenza A/H1N1 infection. In: Journal of the Neurological Sciences. 2012 ; Vol. 321, No. 1-2. pp. 114-116.
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