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Child Neurol Open. 2016 Jul 21;3:2329048X16658845. doi: 10.1177/2329048X16658845. eCollection 2016 Jan-Dec.

Acute Postviral Encephalopathy: Pathologic and Radiologic Correlation in an Atypical Case.

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Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Department of Neurology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Department of Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA.


The authors report a case of fatal acute encephalopathy following influenza infection, with slightly atypical pathological and imaging findings. A healthy 8-year-old boy with probable recent influenza A/B infection admitted for refractory seizures was placed on phenobarbital coma and later developed hemodynamic instability. Magnetic resonance imaging revealed bilateral cerebral and cerebellar white matter lesions and microhemorrhages. Following his demise, the autopsy revealed a large area of necrosis in the right centrum semiovale with similar lesions in the temporal and cerebellar regions. Microscopically, there was extensive coagulative necrosis, compatible with necrotizing white matter encephalopathy, and neuronal loss suggesting superimposed hypoxic-ischemia. The acute progressive neurologic deterioration was partly reminiscent on acute necrotizing encephalopathy, a condition recently associated with influenza A. In acute necrotizing encephalopathy, typical brain findings are characterized by bilateral thalamic necrosis/petechiae with variable white matter edema. The somewhat atypical findings in our case can relate to superadded cardiovascular collapse and hypoxic-ischemic effects.


acute necrotizing encephalopathy; influenza-associated encephalopathy; postviral

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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