IMAGES IN NEUROLOGY
Bithalamic compromise in acute disseminated encephalomyelitis following H1N1 influenza vaccine
Comprometimento bitalâmico na encefalomielite aguda disseminada após vacina H1N1
Artur Furlaneto FernandesI; Paulo Eurípedes MarchioriII
INeurologist, Hospital de Clínicas, University of São Paulo, São Paulo SP, Brazil
IIAssociated Professor of Neurology, Hospital de Clínicas, University of São Paulo, São Paulo SP, Brazil
Correspondence Correspondence: Paulo Eurípedes Marchiori Av. Dr. Enéas Carvalho Aguiar 255 / 5° andar 05403-000 São Paulo SP - Brasil E-mail: marchiori@hcnet.usp.br
A 5- year-old boy was admitted with history of fever, nausea, vomiting and somnolence which had started two days after H1N1 influenza vaccination. Neurological ex-amination showed mild gait ataxia, vertical ophthalmo-paresis and brisk deep tendon reflexes. Brain MRI re-vealed right frontal and bilateral thalamic lesions with increased signal in T2-weighted and flair images (Figs A, B, C, D). Cerebrospinal fluid analysis showed mild lym-phocytic pleocytosis. The patient had a marked clinical improvement after oral corticosteroids was commenced.
Bilateral thalamic lesions have been reported in 12% of pediatric patients with ADEM. This is the first case of ADEM following H1N1 vaccine reported in Brazil.
Received 4 July 2010
Received in final form 18 January 2011
Accepted 25 January 2011
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1Dardiotis E, Kountra P, Kapsalaki E, Protogerou G, Markopoulou K. Acute disseminated encephalomyelitis with bilateral thalamic necrosis. J Child Neurol 2009;24:1001-1004.
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2Tenembaum S, Chitnis T, Ness J, Hahn JS. Acute disseminated encephalo-myelitis. Neurology 2007;68(Suppl 2):S23-S36.
Publication Dates
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Publication in this collection
19 July 2012 -
Date of issue
June 2011