PP04.7 – 2998: H1N1 cerebral vasculitis: A case report on 5 years old boy

Abstract

Objective Report a case of a 5 years old boy, previously healthy, that few days after the diagnosis of H1N1 virus infection, began to develop neurological signs, characterized at first by left central facial palsy, followed two days later by complete left hemiparesis. There was severe drowsiness only on the first day. The pacient did not had seizures, speech disorders, nor altered mental status. Methods The pacient was submitted to a complete laboratory study that did not show abnormalities. The Cerebral Spinal Fluid did not shows abnormalities. The MRI demonstrated subacute ischaemic areas on right basal ganglia, parts of internal capsule, thalamus and corona radiata. The MRI Angiography demonstrated middle cerebral artery stenosis in the M1 segment and A1 stenosis of the anterior cerebral artery. Results After three weeks of the first neurological symptons, there was almost complete recovery of the neurological impairement, only observed by a discrete gait instability and reflex assimetry. A new MRI was performed three months later, that demonstrated gliosis in the white matter in right internal capsule, and basal ganglia. The MRI Angiography had become almst normal, with progressive recovery of the blood flow. He just received oral corticosteroid and antiplatelet therapy. Conclusion Reports of H1N1 with stroke secondary to cerebral vasculitis are rare and use to be related with immunization. Apparently, the prognosis suggests to the good, as we can observe by the progressive recovery dispite the first clinical signs and MRI abnormal findings. Maybe this viral cerebral vasculits can be compared with post-varicella cerebral vasculits on the prognosis and physiopatology, but more cases and investigation must to be done.