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Child Neurology: Remarkable Recovery From Severe Acute Necrotizing Encephalopathy
Andrew Silverman1, Matthew Sasaki1, José Eduardo Espíndola Lima1
1From the Child Neurology Division (A.S., M.S., J.E.E.L., C.C., G.L.L., A.J., K.V.H.), Department of Neurology, Pediatric Neuroradiology (H.D.), Department of Radiology, Infectious Disease Division (E.A.), and Critical Care Medicine (K.G., T.J.L.), Department of Pediatrics, and Neuroimmunology Division (K.V.H.), Department of Neurology, Stanford Medicine, Palo Alto, CA.
A rare pediatric influenza-associated encephalitis, acute necrotizing encephalopathy, can cause severe brain injury. Prompt diagnosis and intensive care, including immunotherapy, led to a remarkable recovery in a 6-year-old girl.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurocritical Care
Background:
- Acute necrotizing encephalopathy (ANE) is a rare, severe neurological complication often linked to influenza infections in children.
- While genetic factors are implicated, many cases remain idiopathic, posing diagnostic challenges.
- ANE presents with characteristic brain imaging findings and significant morbidity/mortality risks.
Purpose of the Study:
- To describe a case of ANE in a previously healthy child.
- To highlight the diagnostic and management complexities of ANE.
- To emphasize the potential for favorable outcomes with timely intervention.
Main Methods:
- Case report of a 6-year-old girl with fever and seizure.
- Diagnostic workup included laboratory tests (PCR for influenza A) and brain MRI.
- Management involved intensive care unit support, immunotherapy (corticosteroids, plasmapheresis), and antiviral treatment.
Main Results:
- The patient presented with influenza A infection and subsequent ANE, confirmed by MRI showing extensive brain lesions.
- Hospitalization required intensive management for encephalopathy and intracranial pressure crises.
- Despite initial severity, the patient achieved a remarkable neurologic recovery within three months.
Conclusions:
- ANE, though rare and potentially devastating, can be managed effectively with prompt diagnosis and aggressive multimodal therapy.
- Intensive care and immunotherapy are crucial for improving neurodevelopmental outcomes in pediatric ANE.
- Neuroprognostication in pediatric intensive care settings remains challenging, underscoring the need for cautious assessment.
