Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 382-389
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.382
Brainstem folding in an influenza child with Dandy-Walker variant
Su-Yun Li, Pei-Qing Li, Wei-Qiang Xiao, Hong-Sheng Liu, Si-Da Yang
Su-Yun Li, Pei-Qing Li, Department of Pediatric Emergency Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
Wei-Qiang Xiao, Hong-Sheng Liu, Department of Radiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
Si-Da Yang, Department of Pediatric Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
Author contributions: Li SY wrote the manuscript; Li PQ provided the clinical data and made manuscript revisions; Xiao WQ read the images obtained by magnetic resonance imaging and wrote the report; Liu HS was responsible for the magnetic resonance imaging review; Yang SD conceived and supervised the study; all authors reviewed the results and approved the final version of the manuscript.
Supported by the Medical Science and Technology Research Foundation of Guangdong, China, No. A2019373; the Innovative Project of Children's Research Institute, Guangzhou Women and Children's Medical Center, China, No. Pre-NSFC-2018-004 and Pre-NSFC-2018-008.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Si-Da Yang, MD, Professor, Department of Pediatric Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, No. 9, Jinsui Road, Guangzhou 510623, Guangdong Province, China. yangsida2013@126.com
Received: November 20, 2019
Peer-review started: November 20, 2019
First decision: December 3, 2019
Revised: December 4, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: January 26, 2020
Processing time: 57 Days and 16 Hours
Abstract
BACKGROUND

Influenza in children is a major cause of morbidity and mortality worldwide. Nervous system diseases are a factor relating to increased mortality rate. However, reports of how these underlying diseases contribute to the death of children with influenza are rare.

CASE SUMMARY

A 4-year-old-girl developed type A influenza-related encephalopathy (IAE) with seizures, acute disorder of consciousness, and intracranial hypertension (cerebrospinal fluid pressure: 250 mmH2O), and the Dandy-Walker variant was found by her first magnetic resonance imaging (MRI) when admission. Three days later, she suddenly presented anisocoria, acute pulmonary edema, and coma, and the later MRI found that she had compressed brainstem, oblongata “Z-like folding”, and swelling bilateral basal ganglia. After admission, the patient were tested for routine and special biomarkers and underwent neuroimaging and neuroelectrophysiology examinations as well as Oseltamivir and intravenous immunogloblin treatments. When predicting that unstable intracranial structures detected by MRI might have disastrous consequences in the progression of IAE, she was transferred into the pediatric intensive care unit and underwent continuous assessment of clinical condition while she did not have instability of basic vital signs; at the same time, her parents were fully informed about the risk and prognosis. Although she was ultimately dead from brain stem failure, the parents expressed understanding and did not trigger a doctor-patient conflict.

CONCLUSION

In case of finding an unstable intracranial structure, intensive care should be given to IAE patient and their clinical condition should be monitored continuously.

Keywords: Influenza-associated encephalopathy; Dandy-Walker variant; Predictive intensive care; Case report

Core tip: Nervous system diseases can increase the mortality rate of influenza, but how these contribute to death is unclear. Here, we report a 4-year-old-girl with congenital brain malformation who progressed to death after getting type A influenza.