Brainstem folding in an influenza child with Dandy-Walker variant

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Neurocritical Care

Background:

• Influenza is a significant cause of childhood morbidity and mortality globally.
• Nervous system diseases are linked to increased mortality in pediatric influenza cases.
• Limited reports exist on the impact of underlying neurological conditions on fatal outcomes in pediatric influenza.

Observation:

• A 4-year-old girl with influenza A developed encephalopathy (IAE), seizures, altered consciousness, and intracranial hypertension.
• Initial MRI revealed a Dandy-Walker variant; subsequent MRI showed brainstem compression, "Z-like folding" of the oblongata, and basal ganglia swelling.
• The patient experienced anisocoria, pulmonary edema, and coma, despite Oseltamivir and IV immunoglobulin treatment.

Findings:

• IAE progression with unstable intracranial structures poses a high risk for severe neurological deterioration.
• Continuous neuroimaging and clinical monitoring are essential for patients with IAE and pre-existing neurological abnormalities.
• Despite intensive care, the patient succumbed to brainstem failure, highlighting the severity of the condition.

Implications:

• Prompt identification of intracranial instability in IAE is critical for initiating intensive care.
• Continuous patient monitoring in a pediatric intensive care unit (PICU) setting is vital for managing IAE complications.
• Understanding the risks and prognosis with families is important, even in fatal cases, to manage expectations and potential conflicts.