[Clinical analysis of seven cases of H1N1 influenza-associated encephalopathy in children].

Objective: To investigate the clinical manifestations, diagnosis, and treatment of H1N1 influenza A-associated encephalopathy (IAE) in children. Methods: The clinical manifestations, laboratory tests, cranial magnetic resonance imaging (MRI), electroencephalography (EEG) examinations and treatments of seven children with H1N1 IAE hospitalized in Guangzhou Women and Children's Medical Center from December 2018 to January 2019 were retrospectively analyzed. Results: Five of the seven children with H1N1 IAE were female. The age at admission was 4 years and 5 months (range 7 months-9 years). Neurological symptoms occurred simultaneously or early (0-3 days) after the flu-like symptom appeared. The main clinical manifestations of neurological symptoms were seizures (repeated seizures in five cases and status convulsion in two cases, including one case of unexpected fever and repeated seizures in a nine-year old girl) accompanied with altered consciousness (drowsiness in five cases and coma in two cases). Cranial MRI in three cases displayed multifocal lesions, mainly in the bilateral thalamus, brainstem and cerebellar hemisphere. MRI also showed reversible splenial lesion in the corpus callusumin in three cases. EEG tracings were characterized by diffuse slow wave activity in four cases, and status epilepticus was monitored in one case. All the 7 cases were treated with oral oseltamivir. Three cases were treated with pulsed methylprednisolone and intravenous immunoglobulin. One case was treated with intravenous immunoglobulin alone and all the patients received oral oseltamivir. All the patients survived, with three patients had minor neurological sequelae at discharge. Conclusions: The main clinical manifestations of H1N1 IAE are seizures and altered consciousness. Cranial MRI combined with EEG is helpful for early diagnosis. Intravenous immunoglobulin and (or) methylprednisolone should be considered for severe cases.目的： 探讨甲型H1N1流行性感冒（流感）相关性脑病患儿的临床特征和诊断及治疗要点。 方法： 回顾性分析2018年12月至2019年1月广州市妇女儿童医疗中心收治的7例甲型H1N1流感相关性脑病患儿的临床表现、实验室检查、头颅磁共振成像（MRI）和脑电图检查结果及治疗和预后情况。 结果： 7例患儿男2例、女5例，就诊年龄4岁7月龄（7月龄~9岁），在流感样症状出现同时或早期（0~3 d）出现神经系统症状，主要表现为惊厥（反复惊厥发作5例，惊厥持续状态2例，其中1例9岁患儿出现与年龄不相符的发热伴反复惊厥发作）和意识改变（5例嗜睡，2例呈昏迷状态）。7例患儿全部进行头颅MRI检查，其中3例见多灶性病变，主要是双侧丘脑，可累及脑干、小脑等部位，3例见可逆性胼胝体压部病变。7例全部行脑电图检查，4例见弥漫性慢波活动，其中1例监测到惊厥持续状态。7例患儿均予奥司他韦口服治疗，3例予冲击剂量甲泼尼龙联合静脉注射用免疫球蛋白治疗，均明显好转出院；其余4例痊愈患儿中1例予单独静脉注射用免疫球蛋白治疗。 结论： 儿童甲型H1N1流感相关性脑病以惊厥和意识改变为主要临床表现，头颅MRI结合脑电图检查有助于早期诊断。重症患儿可应用免疫球蛋白和（或）甲泼尼龙治疗。.