naa a22 4500 510799655 CHVBK 20180411083349.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s12028-013-9880-8 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9880-8 Acute Hemorrhagic Leukoencephalopathy Associated with Influenza A (H1N1) Virus [Elektronische Daten] [Niranjan Jeganathan, Matthew Fox, Julie Schneider, David Gurka, Thomas Bleck] Background: Acute hemorrhagic leukoencephalopathy (AHLE) is a rare condition associated with H1N1. In this condition the infection triggers an autoimmune response which results in perivascular demyelination and hemorrhage in the brain parenchyma. Methods: We report a case of a patient who developed brain edema and herniation as a result of AHLE. Results: A 27-year-old presented to a community hospital with fever, dyspnea, and malaise and was found to have H1N1-associated pneumonia. Despite treatment he progressed to acute respiratory distress syndrome and required mechanical ventilation. Due to failure on conventional ventilation, he was transferred to our hospital and was placed on high-frequency oscillatory ventilation. He was showing improvement until day 6 of transfer to our hospital when he was suddenly noted to have a rise in his blood pressure followed by hypotension. The following morning he was noted to have non-reactive pupils and was declared brain dead. Autopsy of the brain was consistent with AHLE. Conclusions: This case emphasizes the importance of awareness of this disease. The non-specific signs and symptoms, and the use of sedatives, make diagnosis challenging in the early stages of this disease. If suspected early, appropriate imaging can aid in the diagnosis. Treatment with immunosuppressive agents and plasmapheresis may prevent rapid progression and death. This is the first published case of AHLE in association with H1N1 that has been confirmed pathologically. Springer Science+Business Media New York, 2013 Influenza nationallicence H1N1 nationallicence Acute hemorrhagic leukoencephalopathy nationallicence Jeganathan Niranjan Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, 1750W. Harrison Street, Suite 297, 60612, Chicago, IL, USA aut Fox Matthew Department of Pathology and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA aut Schneider Julie Department of Pathology, Rush University Medical Center, Chicago, IL, USA aut Gurka David Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, 1750W. Harrison Street, Suite 297, 60612, Chicago, IL, USA aut Bleck Thomas Division of Pulmonary and Critical Care Medicine, and Section of Infectious Diseases, Departments of Neurological Sciences, Neurosurgery, Medicine, and Anesthesiology, Rush University Medical Center, Chicago, IL, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 218-221 1541-6933 19:2<218 2013 19 12028 https://doi.org/10.1007/s12028-013-9880-8 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9880-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Jeganathan Niranjan Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, 1750W. Harrison Street, Suite 297, 60612, Chicago, IL, USA aut NATIONALLICENCE 700 1- Fox Matthew Department of Pathology and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA aut NATIONALLICENCE 700 1- Schneider Julie Department of Pathology, Rush University Medical Center, Chicago, IL, USA aut NATIONALLICENCE 700 1- Gurka David Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, 1750W. Harrison Street, Suite 297, 60612, Chicago, IL, USA aut NATIONALLICENCE 700 1- Bleck Thomas Division of Pulmonary and Critical Care Medicine, and Section of Infectious Diseases, Departments of Neurological Sciences, Neurosurgery, Medicine, and Anesthesiology, Rush University Medical Center, Chicago, IL, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 218-221 1541-6933 19:2<218 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer