Central Brain Herniation Secondary to Influenza-Related Encephalopathy in a Pontocerebellar Hypoplasia Child: A Case Report and Review

Weiqiang Xiao,Suyun Li,Peiqing Li,Yuzhi Yao,Sida Yang,Hongsheng Liu,Shuyao Ning

doi:10.4236/jbbs.2020.106016

Abstract

Influenza-associated encephalopathy (IAE) can perform as varying patterns of neuroimaging. Central brain herniation (CBH) secondary to IAE is rare; it may be a bad prognosis. Here, we presented a 4-year-old girl with influenza who had a pontocerebellar hypoplasia (PCH) history; she performed the second Magnetic Resonance Imaging (MRI) on Day 6 from onset, showed the diffuse edema and the occurrence of central herniation; the medulla was “Z-like” folded and the basal cisterns were obliterated completely. Finally she was declared dead. The imbalance between supratentorial and infratentorial pressure can lead to the occurrence of CBH. Severe edema relates to IAE and unstable structure of the posterior fossa might be the main reason for the herniation. MRI is helpful in early diagnosis. Early treatment of cerebral edema in patients with congenital abnormalities of the posterior fossa is vital for their management.

Highlights

Influenza in children is a major cause of morbidity and mortality worldwide
We presented a 4-year-old girl with influenza who had a pontocerebellar hypoplasia (PCH) history; she performed the second Magnetic Resonance Imaging (MRI) on Day 6 from onset, showed the diffuse edema and the occurrence of central herniation; the medulla was “Z-like” folded and the basal cisterns were obliterated completely
Severe edema relates to Influenza-associated encephalopathy (IAE) and unstable structure of the posterior fossa might be the main reason for the herniation

Summary

Introduction

Influenza in children is a major cause of morbidity and mortality worldwide. Though only rare cases are severe enough to cause central brain herniation (CBH) [3], the patients with cystic abnormalities or shunting history of posterior fossa might at higher risk of CBH. CBH caused by IAE is rare, but it can lead to high mortality. Central brain herniation (CBH), known as bilateral transtentorial herniation, may occur as a complication of bilateral supratentorial intracranial expansive processes (often acute traumatic or vascular lesions) [4]. Compression of the respiratory and cardiac centers of the reticular substance may lead to irreversible coma or death. Central herniation is the end result of downward displacement of the cerebral hemispheres and the basal nuclei compressing and displacing the diencephalon and the midbrain rostrocaudally through the tentorial notch. There may be downward shifting of the basilar artery and pineal gland [7]

Case Report

Discussion

Conclusion