The Spectrum of Influenza-Associated Acute Necrotizing Encephalopathy of Childhood: A Case Series

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-04-30 DOI:10.1016/j.pediatrneurol.2025.04.012

Janelle Trombley BSc , Catherine Sheppard MD , Gurpreet Khaira MD , Daniel Garros MD , Colin Wilbur MD

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Abstract

Background

Acute necrotizing encephalopathy of childhood (ANEC) is a rare inflammatory neurological disease with characteristic neuroimaging findings commonly leading to disability or death. It is associated with a variety of infectious agents, most commonly influenza.

Methods

This study is a retrospective case series describing three children presenting with ANEC during the 2023-2024 influenza season.

Results

All patients were influenza A positive with a variable duration of prodromal infectious symptoms. Each presented with witnessed or suspected seizures and persistent encephalopathy. Initial computed tomography (CT) was unremarkable in two patients; however, on follow-up neuroimaging all evolved multifocal brain lesions, including symmetric bilateral thalamic involvement consistent with ANEC. All patients received intravenous pulse methylprednisolone, but the timing and selection of additional immunomodulatory interventions differed between patients. Outcomes spanned from slight disability to death.

Conclusions

These patients illustrate the spectrum of ANEC presentations and outcomes and underscore the importance of prompt investigations in children with persistent encephalopathy and prodromal infectious symptoms, even with unremarkable findings on initial CT. The variability in treatment and outcomes within a single center emphasizes the need for further research to establish a better pathophysiologic understanding of ANEC and optimal treatment protocols.

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儿童流感相关急性坏死性脑病的频谱：一个病例系列

儿童急性坏死性脑病（ANEC）是一种罕见的炎症性神经系统疾病，具有特征性的神经影像学表现，通常导致残疾或死亡。它与多种传染因子有关，最常见的是流感。方法本研究是对2023-2024年流感季节期间出现ANEC的3名儿童的回顾性病例系列研究。结果所有患者均为甲型流感阳性，前驱感染症状持续时间不等。每个人都有目击或怀疑癫痫发作和持续性脑病。2例患者初始计算机断层扫描（CT）无显著差异；然而，在后续的神经影像学检查中，所有患者都出现了多灶性脑病变，包括与ANEC一致的对称双侧丘脑受累。所有患者均接受静脉注射甲基强的松龙，但患者之间额外免疫调节干预的时间和选择不同。结果从轻微残疾到死亡不等。这些患者说明了ANEC的表现和结果，并强调了对持续性脑病和前驱感染症状的儿童进行及时调查的重要性，即使在初始CT上没有明显的发现。单一中心内治疗和结果的可变性强调需要进一步研究，以建立对ANEC更好的病理生理学理解和最佳治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.