Transient splenial lesion of the corpus callosum in H1N1 influenza virus-associated encephalitis/encephalopathy

A 26-year-old man was admitted to our hospital because of high fever, drowsiness, memory disturbance, and disorientation due to H1N1 influenza virus-associated encephalitis/encephalopathy. All of his symptoms rapidly improved following methylprednisolone pulse therapy. The diffusion-weighted image of brain magnetic resonance imaging (MRI) revealed a large transient hyperintense signal lesion on the central splenium of the corpus callosum. This MRI finding in conjunction with a complete clinical recovery has been previously observed in cases of clinically mild seasonal influenza-associated encephalitis/encephalopathy, and can be also a useful clue for the diagnosis of new type of influenza, H1N1 influenza virus infection complicated by encephalitis/encephalopathy.     

Reversible splenial lesion syndrome with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome caused by olanzapine

A 27‐year‐old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome. Brain magnetic resonance imaging showed transiently restricted diffusion in the splenium of the corpus callosum, with a high signal intensity on diffusion‐weighted imaging. The neurological abnormalities disappeared along with improvement of metabolic derangements, and the follow‐up magnetic resonance imaging carried out on the 26th day of admission showed complete resolution of the lesions in the splenium of the corpus callosum. These clinical and radiological features are highly suggestive of clinically mild encephalitis/encephalopathy with a reversible splenial lesion. The first case of mild encephalitis/encephalopathy with a reversible splenial lesion caused by olanzapine‐induced hyperosmolar hyperglycemic state and neuroleptic malignant syndrome is reported.     

Focal transient lesions of the corpus callosum in systemic lupus erythematosus

Focal lesions limited to the splenium of the corpus callosum are rare and little is known about their etiology. We describe three patients with systemic lupus erythematosus (SLE) that presented transient lesions of the corpus callosum. We reviewed three patients with SLE whose magnetic resonance imaging (MRI) results revealed focal lesions in the splenum of corpus callosum. The medical records, including clinical, serological, and treatment features, were reviewed to determine the etiology of these lesions. Of 115 patients who had MRI for research purposes, three patients with focal nonhemorrhagic lesions of the corpus callosum were identified. All patients had active SLE at the time of MRI. One patient had other findings on MRI, including cerebral venous thrombosis. On follow-up MRI, patients had an inactive disease and the corpus callosum lesions disappeared. A transient lesion in the splenium of corpus callosum seems to be a nonspecific endpoint of different disease processes leading to vasogenic edema. The complete and rapid reversibility in all cases with disease control is emphasized and any invasive diagnostic or therapeutic approach is discouraged.     

Transient Probst Bundle Diffusion Restriction: An Acute Encephalopathy Equivalent to Clinically Mild Encephalopathy with a Reversible Splenial Lesion

Probst bundles are selectively seen in patients with agenesis of the corpus callosum (CC) and are thought to be homologous to the CC. We herein report a 19-year-old woman with partial agenesis of the CC. She developed acute encephalopathy during Bordetella pertussis infection. Brain magnetic resonance imaging (MRI) showed restricted diffusion of bilateral Probst bundles. She was treated with anti-epileptics and azithromycin and recovered with no neurological sequelae. Follow-up MRI showed the resolution of the diffusion abnormality. The characteristics of diffusion-weighted images on brain MRI and clinical course mimicked those in cases of clinically mild encephalopathy/encephalitis with reversible splenial lesion.     

Nonconvulsive status epilepticus manifesting as rapidly progressive dementia and infarction in the splenium of the corpus callosum: A case report

Rationale:Nonconvulsive status epilepticus (NCSE) is a heterogeneous disease with multiple subtypes. NCSE poses great diagnostic and therapeutic challenges due to the lack of typical symptoms. Here, we report a case of NCSE manifesting as rapidly progressive dementia (RPD) and infarction in the splenium of the corpus callosum. Additionally, the relevant literature was reviewed.Patient concerns:A 63-year-old man presented with RPD. Electroencephalogram (EEG) revealed NCSE, and brain magnetic resonance imaging (MRI) showed an isolated infarction in the splenium of the corpus callosum. Mini-mental state examination showed moderate cognitive impairment (14/30 points).Diagnosis:A diagnosis of NCSE with RPD and infarction in the splenium of the corpus callosum was made.Interventions:The patient was treated with intravenous diazepam (10 mg), oral levetiracetam (1.0g twice daily), oral sodium valproate (0.2g twice daily), and intramuscular phenobarbital sodium (0.2g once daily).Outcomes:After the treatment, the symptoms were improved. The patient could answer questions. Repeated EEG showed that the background a rhythm was slightly overdeveloped, and no clinical or electrical seizures were observed. After discharge, the patient was treated with oral levetiracetam (1.0g twice daily) and oral sodium valproate (0.2g twice daily) for 6 months. At the last follow-up, the patient had clear consciousness, sensitive response, and fluent answering ability. Repeated mini-mental state examination showed that his cognitive function was significantly improved (28/30 points); nevertheless, the lesion in the splenium of corpus callosum remained unchanged on MRI.Lessons:NCSE manifesting as RPD and infarction in the splenium of the corpus callosum is extremely rare. Epileptic events and focal infarction are usually overlooked in patients with dementia, and the diagnostic value of MRI and EEG should be highlighted     

胼胝体梗死的临床与影像学分析

目的 探讨胼胝体梗死患者的临床和影像学特点.方法 收集符合脑梗死诊断的416例患者的临床资料,其中8例经过MRI证实为胼胝体梗死.结果 胼胝体梗死占全部脑梗死患者的1.9%.7例CT扫描未显示胼胝体梗死,经非增强MRI检查显示病灶,另1例经增强MRI检查显示病灶.梗死灶可仅累及胼胝体(膝部、体部或压部),也可合并额叶、...     

Encephalopathy with isolated reversible splenial lesion of the corpus callosum

We report a 51-year-old Japanese man with chronic alcoholism who complained of mental confusion following respiratory and intestinal infections. The splenium of the corpus callosum showed hyperintensity on both diffusion-weighted MR images and fluid-attenuated inversion recovery images and hypointensity on T1-weighted images. These findings were resolved on MR images obtained 3 days later. He showed complete neurological recovery within 2 months. We suspected that he had mild encephalopathy with a reversible splenial lesion after systemic viral or bacterial infection.     

Relationship between respiratory viral load and lung lesion severity: a study in 24 cases of pandemic H1N1 2009 influenza A pneumonia

Objective

To investigate the relationship between respiratory viral load and lung lesion severity of patients with pandemic H1N1 2009 influenza A pneumonia.

Study design

Cross-sectional observation study.

Methods

24 consecutive H1N1 influenza patients with viral pneumonia (13 males, 11 females, mean age: 17.5 years) during their presentation to hospital were retrospectively analysed. Viral load were first measured on average 5.2 days after the onset of symptoms. The initial CT and viral load measurement was carried on the same day in 13 patients. The rest were carried out with a mean interval time of 1.5 days. All patients had viral load follow-up till turned negative. Thirteen patients had radiological follow-up.

Results

There was no significant correlation between the initial lung lesion severity and viral load (P=0.4). Both viral load and lung lesion severity decreased over time, being highest value at initial presentation. The patients had higher initial viral load or higher initial lung lesion severity tended to be slower in resolving. The lung lesion decreased at a slower rate than viral load.

Conclusions

While there was no correlation between the initial viral load and lung lesion severity, these two indices provide valuable information for epidemiological control.Key Words : Chest X-ray, tomography, computed, pandemic, lung, infection, viral load, influenza A (H1N1)2009, real time RT-PCR     

甲型H1N1流行性感冒56例流行病学和临床学分析

目的 了解学校甲型H1N1流行性感冒(流感)暴发的流行病学和临床特征.方法 将56例确诊患者的流行病学调查和临床资料录入EPIDATA数据库,采用STATA软件分析其流行病学和临床学特点,采用RT-PCR法进行甲型H1N1流感病毒核酸检测.率的比较采用χ2检验,多个样本均数的比较采用单因素方差分析.结果 50例患者为同一小学学生,5例为密切接触者,发病高峰为2009年6月18日和19日.患者从发病至就诊、发病至人院、病程及住院时间的中位数分别为0、2、6和7 d.主要临床表现为发热56例、咳嗽54例、咳痰31例、扁桃体肿大25例和咽痛18例.合并症的发生率为10.7%(6例),主要为急性支气管炎.患者在发病后7 d之内、发病8～10 d及10 d以上咽拭子甲型H1N1流感病毒核酸阳性率分别为74.39%、5.13%和0,差异有统计学意义(χ2=95.0412,P＜0.01).单用奥司他韦治疗,奥司他韦联合中药治疗及单用中药治疗患者的病程分别为8.88、9.31和10 d,差异无统计学意义(F=0.37,P=0.6927).17例有可疑接触史患者的平均潜伏期为1 d.结论 甲型H1N1流感病情温和,其流行病学和临床表现与普通季节性流感类似.建议将甲型H1N1流感传染期判断标准调整为患者自出现症状前1 d至发病后10 d.     

32例无基础疾病者甲型H1N1流感危重症特点分析

目的 了解无基础疾病者感染甲型H1N1流感危重症的临床特点、治疗和转归.方法 观察北京地坛医院2009年10月3日-12月31日收治的32例无基础疾病者感染甲型H1N1流感危重症的临床特点、主要治疗和转归.结果 危重症易发生于65岁以下(96.9％)及肥胖者(71.0％).甲型H1N1流感危重症临床特点为高热(96.9...     

广东省首例输人性甲型H1N1流行性感冒临床分析

目的 了解2009年广东省首例输入性甲型H1N1流行性感冒(流感)病例的流行病学、临床、病原学特点及预后转归.方法 对该例成年男性患者流行病学及临床资料进行回顾性分析,并采用实时荧光PCR法检测甲型H1N1流感病毒核酸.结果 该患者赴加拿大、美国自助旅游3周,2009年5月14日发病,次日回国入境检疫时有发热,即转送广州市第八人民医院隔离治疗.其临床表现以咽痛、干咳、鼻塞起病,后出现发热、全身肌肉酸痛、乏力、纳差等流感症状,无肺炎等并发症.WBC总数在发病初期升高,后期降低.咽拭子检测甲型H1N1流感病毒核酸阳性,病毒分离后测序结果显示与美国分离株高度相似.患者经抗病毒及对症支持治疗后痊愈出院.结论 该患者临床表现典型,确诊为广东省首例输入性甲型H1N1流感.     

Influenza-associated bacterial pathogens in patients with 2009 influenza A (H1N1) infection: impact of community-associated methicillin-resistant Staphylococcus aureus in Queensland, Australia

Background: Secondary bacterial pneumonia due to community onset methicillin‐resistant Staphylococcus aureus (MRSA) has become a highly publicised cause of influenza‐associated death. There is a risk that case reports of fatal outcomes with post‐influenza MRSA pneumonia may unduly influence antibiotic prescribing. Aims: The aim of this study was to demonstrate the incidence of community‐onset MRSA pneumonia in 2009 H1N1 influenza patients. Methods: The microbiology records of patients positive for influenza A (H1N1) in 2009 were reviewed for positive blood or respiratory tract cultures and urinary pneumococcal antigen results within a Queensland database. Patients with such positive results within 48 h of hospital admission and a positive H1N1 influenza result in the prior 6 weeks were included. Results: In 2009, 4491 laboratory‐confirmed pandemic influenza A (H1N1) infections were detected. Fifty patients (1.1% of the H1N1 cohort) who were hospitalised with H1N1 and who had a bacterial respiratory tract pathogen were identified. Streptococcus pneumoniae (16 patients; 32%), Staphylococcus aureus (13 patients; 26%) and Haemophilus influenzae (9 patients; 18%) were the most commonly cultured organisms. Of the cohort of 4491 patients, MRSA was detected in only two patients, both of whom were admitted to intensive care units and survived after prolonged admissions. Conclusions: Influenza‐associated community‐onset MRSA pneumonia was infrequently identified in the 2009 H1N1 season in Queensland, despite community‐onset MRSA skin and soft tissue infections being very common. Although post‐influenza MRSA pneumonia is of great concern, its influence on empiric‐prescribing guidelines should take into account its incidence relative to other secondary bacterial pathogens.     

Abnormal brain MRI signals in the splenium of the corpus callosum, basal ganglia and internal capsule in a suspected case with tuberculous meningitis

A 34-year-old man visited the hospital with chief complaints of headache, fever, and disturbance of consciousness. In view of his clinical condition, the course of the disease, and results of examination, he was diagnosed with viral meningitis and treated accordingly. However, his clinical condition worsened, and MRI revealed abnormal signals in the splenium of the corpus callosum, in the basal ganglia and in the internal capsule, as well as the presence of severe inflammation in the base of the brain. Since he had a high ADA level in the cerebrospinal fluid and was consequently suspected to have tuberculous meningitis, he was placed on antitubercular agents. Then, his clinical condition began to improve. Additional steroid pulse therapy further improved his condition, and abnormal signals in the splenium of the corpus callosum and the basal ganglia resolved. This valuable case suggests that an immune mechanism contributed to the occurrence of central nervous system symptoms associated with tuberculous meningitis.     

Novel H1N1 influenza A virus infection in a patient with acute rejection after liver transplantation

BACKGROUND:The 2009 H1N1 influenza A virus was first identified in April 2009 and rapidly evolved into a pandemic. Recipients of solid-organ transplants have a higher risk for severe infection because of immunosuppression.There are limited reports of 2009 H1N1 influenza in liver transplant recipients,especially in China. METHODS:We present a case of a 48-year-old male liver transplant recipient with 2009 H1N1 influenza A virus.He received therapy for acute rejection after transplantation and was confirmed with H1N1 virus infection. RESULTS:The patient was started on oseltamivir(75 mg, orally twice daily)and had a benign hospital course,with defervescence and resolution of symptoms within 72 hours. The follow-up chest radiograph after discharge was normal. CONCLUSIONS:The 2009 H1N1 influenza in this hospitalized transplant recipient was relatively mild,and prolonged viral shedding was not noted.Oseltamivir can be a valid measure in immunocompromised individuals.     

An outbreak of the 2009 influenza a (H1N1) virus in a children's hospital

Please cite this paper as: Bearden et al. (2012) An outbreak of the 2009 influenza a (H1N1) virus in a children’s hospital. Influenza and Other Respiratory Viruses 6(5), 374–379. Context Preventing nosocomial transmission of influenza is essential to reduce the morbidity and mortality associated with this infection. In October 2009, an outbreak of the 2009 influenza A (H1N1) virus occurred in a hematology ward of a children’s hospital over a 21‐day period and involved two patients and four healthcare workers. Objective To investigate nosocomial transmission of the 2009 influenza A (H1N1) virus in patients and healthcare workers. Design, setting, and participants An outbreak investigation was initiated in response to suspected nosocomial transmission of the 2009 influenza A (H1N1) virus during the peak of the 2009 pandemic. Cases were confirmed using a polymerase chain reaction (PCR) test specific for the 2009 H1N1 influenza A virus. Viruses isolated from nasopharyngeal swabs were genetically characterized using Sanger sequencing of uncloned “bulk” PCR products. Main outcome measures Virus sequencing to investigate nosocomial transmission. Results Two immunocompromised patients and four healthcare workers were found to be part of a nosocomial outbreak of the 2009 influenza A (H1N1) virus. One immunocompromised patient had a second episode of clinical influenza infection after isolation precautions had been discontinued, resulting in additional exposures. Strain‐specific PCR showed that all cases were caused by infection of the 2009 H1N1 virus. Sequencing of viral genes encoding hemagglutinin and polymerase basic subunit 2 (PB2) revealed that all viruses isolated were genetically identical at these loci, including the two episodes occurring in the same immunocompromised patient. Conclusions Prompt institution of isolation precautions is essential in preventing nosocomial outbreaks of the 2009 novel influenza A (H1N1) virus. Our data suggest that isolation precautions may need to be continued for a prolonged period of time in immunocompromised patients with influenza infection.     

2009 pandemic Influenza A (H1N1): clinical and laboratory characteristics in pediatric and adult patients and in patients with pulmonary involvement

Please cite this paper as: Lee and Liu et al. (2012) 2009 pandemic Influenza A (H1N1): clinical and laboratory characteristics in pediatric and adult patients and in patients with pulmonary involvement. Influenza and Other Respiratory Viruses 6(601), e152–e161. Background To better understand clinical and laboratory characteristics in children, adults, and patients with lung involvement suffering 2009 pandemic influenza A (H1N1). Methods A total of 442 patients with 2009 pandemic influenza A (H1N1) were retrospectively analyzed. Results Comparing to their adult counterpart (n = 55), pediatric patients (n = 387) had significantly higher frequencies of fever, rhinorrhea, cough, sore throat, nausea/vomiting, and longer length of fever; lower frequencies of chest pain and dyspnea; higher incidence of lymphopenia; and lower incidence of elevated serum C‐reactive protein. Among the 227 patients with radiographs available, lung involvement was found in 19 (8·4%) (52·6% consolidation and 47·4% interstitial infiltrations), including 18 children and one adult. One child with lung consolidation died of multiorgan failure. Significant findings in patients with lung involvement included predominant young age (≤10 years), prolonged fever, and delayed oseltamivir therapy (≥48 hours after onset of illness); higher frequencies of dyspnea, nausea/vomiting, and altered consciousness; and higher incidences of leukopenia, elevated serum creative kinase, and lactic dehydrogenase. Conclusions Among patients with 2009 pandemic influenza A (H1N1), we found significant difference in clinical manifestations between children and adults, and significant differences in clinical and laboratory manifestations between patients with lung involvement and those without. On the basis of data from this study and the existing literature, early treatment with oseltamivir is recommended for patients with 2009 pandemic influenza A (H1N1), regardless of age.     

儿童甲型H1N1流行性感冒病毒相关性肺炎的临床特征

目的 了解儿童甲型H1N1流行性感冒(流感)病毒相关性肺炎的临床流行特征.方法 通过描述性研究对2009年上海复旦大学附属儿科医院收治的30例甲型H1N1流感病毒所致肺炎的患儿做临床及流行病学分析.中位数比较采用秩和检验,率的比较采用精确卡方检验.结果 30例确诊为甲型H1N1流感合并肺炎的患儿中,年龄中位数为5.9岁,5例有基础疾病史,占16.7%.有明确发热病例暴露史的20例,占66.7%.所有患儿均有发热和咳嗽,11例伴气促,占36.7%,10例伴喘息,占33.3%.11例患儿WBC＜4.0×109/L,占36.7%,2例PLT减少,占6.7%.所有患儿入院时胸部X线片提示肺部有单侧或双侧片状渗出性病灶,4例危重症患儿肺部多处大片状渗出伴肺水肿,占13.3%,1例危重症肺炎患儿发病后3个月和9个月复查胸部CT提示不同程度肺纤维化,占3.3%,3例同时伴纵隔积气和皮下积气,占10.0%,6例并发急性呼吸衰竭,占20.0%,3例伴支气管哮喘急性发作,占10.0%,1例合并脑炎,占3.3%.所有患儿均给予奥司他书和抗菌药物治疗,4例接受机械通气,均治愈或好转出院.发病2 d内和2 d后接受奥司他韦治疗的患儿的热程中位数比较差异有统计学意义(2 d比5 d,Z=-8.015,P＜0.01).结论 学龄前和学龄儿童易感染甲型H1N1流感病毒,可并发严重的肺部疾病.在发病早期采用奥司他韦治疗,可缩短热程,降低危重并发症的发生.     

Multiple symptoms of higher brain dysfunction caused by Marchiafava–Bignami disease in a patient with dermatomyositis

A 65-year-old woman with dermatomyosi tis (DM) was admitted because of disorientation, mental dysfunction, and disturbance of consciousness. Prior to admission, she suffered from septic and hypovolemic shock. There was no evidence of active DM on physical examination and laboratory tests. Cerebrospinal fluid examination revealed no signs of meningitis. Because of clinical symptoms and findings on magnetic resonance images, such as the lesion in the splenium of the corpus callosum that was a low-intensity area on T1-weighted images and a high intensity on T2-weighted images; she was diagnosed as Marchiafava–Bignami disease (MBD). She received a combination of vitamin B, vitamin E, vitamin C, and nicotinic acid. Her symptoms improved gradually, and she was discharged at 1.5 months after admission. There has been no report of a case of DM with MBD. This report may provide useful data with regard to the mechanisms of central nervous system (CNS) disorders in patients with DM.     

Isolated reversible splenial lesion in adult meningitis: a case report and review of the literature

We report the rare case of a 38-year-old man who suffered from aseptic meningitis. Brain magnetic resonance imaging showed an ovoid lesion with a high signal intensity on T2- and diffusion-weighted images in the splenium of the corpus callosum that completely disappeared within a week. There were no symptoms or signs associated with the lesion, and the prognosis was good. Although rare in adult patients, awareness of a reversible splenial lesion in meningoencephalitis is important.