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Neurocritical Care

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01-08-2011 | Practical Pearl

Outcome in Patients with H1N1 Influenza and Cerebrovascular Injury Treated with Extracorporeal Membrane Oxygenation

Authors: Felicia C. Chow, Brian L. Edlow, Matthew P. Frosch, William A. Copen, David M. Greer

Published in: Neurocritical Care | Issue 1/2011

Abstract

Background

Although intracranial hemorrhage and infarction have been reported in patients with H1N1 influenza infection treated with extracorporeal membrane oxygenation (ECMO), the clinical outcomes of these patients are not well described.

Methods

The authors present two patients with H1N1 influenza infection and diffuse cerebrovascular injury in the setting of ECMO.

Results

Diffuse cerebrovascular injury including intraparenchymal hemorrhage was found on head CT and brain MRI in both cases and confirmed by autopsy in one patient who died. Punctate foci of susceptibility effect were seen in both patients on T2* susceptibility-weighted or susceptibility-sensitive gradient echo sequences. These foci of susceptibility effect were consistent with infarction on histopathologic evaluation in the patient who died. The other patient made an excellent clinical recovery.

Conclusions

Frequent and early surveillance imaging should be obtained in patients with H1N1 influenza infection undergoing ECMO, although the presence of diffuse cerebral injury, including intraparenchymal hemorrhage and multifocal punctate susceptibility effect, does not necessarily portend a poor prognosis.

CDC Estimates of 2009 H1N1 Influenza Cases: Hospitalizations and deaths in the United States. April 2009–February 13, 2010. 2010. www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm.

Nin N, Soto L, Hurtado J, et al. Clinical characteristics and outcomes of patients with 2009 influenza A (H1N1) virus infection with respiratory failure requiring mechanical ventilation. J Crit Care. 2010; doi:10.1016/j.crc.2010.05.031.

Davies A, Jones D, Bailey M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–95.PubMedCrossRef

Miller RR 3rd, Markewitz BA, Rolfs RT, et al. Clinical findings and demographic factors associated with ICU admission in Utah due to novel 2009 influenza A(H1N1) infection. Chest. 2010;137:752–8.PubMedCrossRef

Lidegran MK, Mosskin M, Ringertz HG, et al. Cranial CT for diagnosis of intracranial complications in adult and pediatric patients during ECMO: clinical benefits in diagnosis and treatment. Acad Radiol. 2007;14:62–71.PubMedCrossRef

Weitkamp JH, Spring MD, Brogan T, et al. Influenza A virus-associated acute necrotizing encephalopathy in the United States. Pediatr Infect Dis J. 2004;23:259–63.PubMedCrossRef

Lyon JB, Remigio C, Milligan T, Deline C. Acute necrotizing encephalopathy in a child with H1N1 influenza infection. Pediatr Radiol. 2010;40:200–5.PubMedCrossRef

Zanatta P, Forti A, Bosco E, et al. Microembolic signals, strategy to prevent gas embolism during extracorporeal membrane oxygenation. J Cardiothorac Surg. 2010;5:5.PubMedCrossRef

Jonas RA. The effect of extracorporeal life support on the brain: cardiopulmonary bypass. Semin Perinatol. 2005;29:51–7.PubMedCrossRef

10.

Dexter F, Hindman BJ. Recommendations for hyperbaric oxygen therapy of cerebral air embolism based on a mathematical model of bubble absorption. Anesth Analg. 1997;84:1203–7.PubMed

11.

Jeon S-B, Kang D-W. Neurological picture. Cerebral air emboli on T2-weighted gradient-echo magnetic resonance imaging. J Neurol Neurosurg Psychiatr. 2007;78:871.PubMedCrossRef

12.

Idbaih A, Boukobza M, Crassard I, et al. MRI of clot in cerebral venous thrombosis: high diagnostic value of susceptibility-weighted images. Stroke. 2006;37:991–5.PubMedCrossRef

13.

Boukobza M, Crassard I, Bousser MG, Chabriat H. MR imaging features of isolated cortical vein thrombosis: diagnosis and follow-up. AJNR Am J Neuroradiol. 2009;30:344–8.PubMedCrossRef

14.

Kim HS, Lee DH, Choi CG, et al. Progression of middle cerebral artery susceptibility sign on T2*-weighted images: its effect on recanalization and clinical outcome after thrombolysis. AJR Am J Roentgenol. 2006;187:W650–7.PubMedCrossRef

Title: Outcome in Patients with H1N1 Influenza and Cerebrovascular Injury Treated with Extracorporeal Membrane Oxygenation
Authors: Felicia C. Chow
Brian L. Edlow
Matthew P. Frosch
William A. Copen
David M. Greer
Publication date: 01-08-2011
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 1/2011
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-011-9534-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcome in Patients with H1N1 Influenza and Cerebrovascular Injury Treated with Extracorporeal Membrane Oxygenation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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