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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Neuroscience
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Acute childhood encephalitis and encephalopathy associated with influenza: a prospective 11-year review.Pediatr Infect Dis J. 2008; 27: 390-395
- Pandemic influenza A (H1N1) 2009 with neurological manifestations, a case series.Influenza Other Resp Viruses. 2010; 4: 117-120
- Hypercytokinemia and hyperactivation of phospho-p38 mitogen-activated protein kinase in severe human influenza A virus infection.Clin Infect Dis. 2007; 45: 723-731
- First evidence of a pro-inflammatory response to severe infection with influenza virus H1N1.Crit Care. 2010; 14: 115
- H1N1 Encephalitis with Malignant Edema and Review of Neurologic Complications from Influenza.Neurocrit Care. 2010; 13: 396-406
- Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection.N Engl J Med. 2010; 362: 1708-1719
- Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico.N Engl J Med. 2009; 361: 680-689
- Heightened neurologic complications in children with pandemic H1N1 influenza.Ann Neurol. 2010; 68: 762-766
- Critically ill patients with 2009 influenza A(H1N1) in Mexico.JAMA. 2009; 302: 1880-1887
Neurologic complications associated with novel influenza A (H1N1) virus infection in children – Dallas, Texas, May 2009. MMWR Morb. Mortal Wkly Rep 2009;58:773–8.
- Neurologic Manifestations of Pediatric Novel H1N1 Influenza Infection.Pediatr Infect Dis J. 2011; 30: 165-167
- Neurologic and muscular complications of the 2009 influenza A (H1N1) pandemic.Curr Neurol Neurosci Rep. 2010; 10: 476-483
- Lipopolysaccharide treatment and inoculation of influenza A virus results in influenza virus-associated encephalopathy-like changes in neonatal mice.J Neurovirol. 2010; 16: 125-132
- Clinical practice. The syndrome of inappropriate antidiuresis.N Engl J Med. 2007; 356: 2064-2072
Accepted: January 28, 2011
Received: January 7, 2011
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.