Abstract
Acute encephalitis, encephalopathy, and seizures are known rare neurologic sequelae
of respiratory tract infection with seasonal influenza A and B virus, but the neurological
complications of the pandemic 2009 swine influenza A (H1N1) virus, particularly in
adults, are ill-defined. We document two young adults suffering from H1N1-associated
acute respiratory distress syndrome and renal failure who developed cerebral edema.
The patients acutely developed a transtentorial brain herniation syndrome including
a unilateral third nerve palsy (dilated and unresponsive pupils), elevated intracranial
pressure, coma, and radiological evidence of diffuse cerebral edema. In both patients,
neurological deterioration occurred in the context of hyponatremia and a systemic
inflammatory state. These patients illustrate that severe neurologic complications,
including malignant cerebral edema, can occur in adults infected with H1N1 virus,
and illustrate the need for close neurological monitoring of potential neurological
morbidities in future pandemics.
Keywords
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Article info
Publication history
Accepted:
January 28,
2011
Received:
January 7,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
