H1N1 encephalitis with malignant edema and review of neurologic complications from influenza.

BACKGROUND: Influenza virus infection of the respiratory tract is associated with a range of neurologic complications. The emergence of 2009 pandemic influenza A (H1N1) virus has been linked to neurological complications, including encephalopathy and encephalitis. METHODS: Case report and literature review. RESULTS: We reviewed case management of a 20-year old Hispanic male who developed febrile upper respiratory tract signs and symptoms followed by a confusional state. He had rapid neurologic decline and his clinical course was complicated by refractory seizures and malignant brain edema. He was managed with oseltamavir and peramavir, corticosteroids, intravenous gamma globulin treatment, anticonvulsants, intracranial pressure management with external ventricular drain placement, hyperosmolar therapy, sedation, and mechanical ventilation. Reverse transcriptase polymerase chain reaction analysis of nasal secretions confirmed 2009 H1N1 virus infection; cerebrospinal fluid (CSF) was negative for 2009 H1N1 viral RNA. Follow-up imaging demonstrated improvement in brain edema but restricted diffusion in the basal ganglia. We provide a review of the clinical spectrum of neurologic complications of seasonal influenza and 2009 H1N1, and current approaches towards managing these complications. CONCLUSIONS: 2009 H1N1-associated acute encephalitis and encephalopathy appear to be variable in severity, including a subset of patients with a malignant clinical course complicated by high morbidity and mortality. Since the H1N1 influenza virus has not been detected in the CSF or brain tissue in patients with this diagnosis, the emerging view is that the host immune response plays a key role in pathogenesis.

Slippery platelet syndromes in subdural hematoma.

BACKGROUND: This study investigates platelet dysfunction in patients with subdural hematomas (SDH) using platelet function analysis (PFA). METHODS: PFA using the PFA-100 (Dade International Inc., Miami, FL) was performed at admission using the collagen-epinephrine and collagen-ADP assays in 58 SDH patients. Clinical and radiologic information was collected. RESULTS: Normal PFA results were present in 36 patients (62%; PFA collagen:epinephrine assay (s) 118 ave; PFA collagen:adenosine diphosphate assay (s) ave 75) and abnormal platelet function in 22 patients (38%; PFA collagen:epinephrine assay (s) 231 average; PFA collagen:adenosine diphosphate assay (s) 124 average). Compared to patients with normal PFA results, patients with abnormal PFA results were more likely to have hypertension (22 vs. 55%; P = 0.01), take clopidogrel (3 vs. 32%; P = 0.001), and use anti-platelet medications and non-steroidal anti-inflammatory agents (22 vs. 59%; P = 0.004). Measurements of baseline CT for midline shift, maximum thickness, presence of blood/fluid levels in the hematoma, and presence of additional sites of intracranial bleeding did not reveal significant differences based on PFA testing. Platelet dysfunction improved after platelet transfusions (PFA collagen:epinephrine assay: baseline 270 s, CI 61 s; after transfusion 124 s, CI 50 s, P < 0.001). CONCLUSION: Platelet dysfunction was found in 38% of SDH patients. This finding adds to our understanding of the pathophysiology of SDH. Since platelet transfusions are indicated for platelet dysfunction accompanied by major bleeding or need for surgery, these results impact peri-operative management.

How effective are "community" stroke screening programs at improving stroke knowledge and prevention practices? Results of a 3-month follow-up study.

BACKGROUND AND PURPOSE: Community stroke screening is a commonly used prevention strategy to identify and educate those at risk. Although the goal of this approach is to reduce the overall occurrence of stroke, its long-term benefit remains unknown. The purpose of this study was to determine whether attendance of a stroke screening changes knowledge or prevention practices in persons at risk for stroke 3 months later. METHODS: A stroke screening event was held following the National Stroke Association guidelines, with health screening, counseling, and education. Knowledge about stroke was measured by a questionnaire before and after the event. At 3 months, attendees identified at risk for stroke were contacted by telephone to determine their retained knowledge and any specific actions taken as a result of the health counseling. RESULTS: At 3 months, 78 persons were contacted. Knowledge of stroke warning signs increased from 59% to 94% after screening but decreased to 77% at 3 months. At 3 months, 73% had done nothing to change their health practices. CONCLUSIONS: Community stroke screening has modest effects on health behavior, knowledge of stroke risk factors, and warning signs.