Influenza-associated encephalopathy with a clinic of а brain edema

Abstract

Influenza virus associated encephalopathy is a syndrome, characterized by an acute onset of neurological dysfunction in the context of influenza infection, by an elevated protein level or/and cerebral edema and by lack of pleocytosis.
We present the case of a boy, 4 years old, who, during a chicken pox infection in a reconvalescent phase and an additional influenza infection with a high temperature, experienced severe headache, nausea, vomiting and had persistent nasal eye deviation, drowsiness and confusion. The cerebrospinal fluid was tested and was with normal parameters. Influenza virus type A, H3N2 was serologically confirmed. The ophthalmoscopy showed papilledema (2D). The first CT revealed narrowed lateral ventricles, the next CT, performed 10 days later, showed fronto-parietal hypodense white matter lesions, that later disappeared after antiedema, antivirus and symptomatic therapy. When the patient was admitted in the Clinic of Child neurology the only neurological deficit was bilateral abducens nerve palsy. The ophthalmoscopy showed papilledema (0.25D). A proper antiedema therapy with acetazolamide and corticosteroids was initiated. We observed gradual improvement with decrease of the headache and improvement in the volume of the eye movement.
We describe a case of a mild form of influenza-associated encephalopathy in which the leading symptoms were those of a cerebral edema with quantitative changes of consciousness.
After the initial period the antiedema therapy is the main therapeutic approach, with a strict monitoring of the papilledema.