Objectives: To summarize the characteristics and research progress of influenza-associated brain complications in children and provide references for early diagnosis and brain protection treatment. Methods: Studied published articles of influenza-associated neurocomplications in children from PubMed and summarizes them from epidemiology, clinical manifestations, diagnosis and treatment, and basic research progress. Results: Common brain complications in flu-children include febrile seizures, influenza-associated encephalopathy (IAE), acute or post-influenza encephalitis, and the most severe condition is acute necrotizing encephalopathy (ANE). However, the mechanism and relevant factors of influenza-associated brain damage have not been elucidated. Conclusion: Influenza could be accompanied by various brain lesion complications in dif ferent stages of the disease, some of which are life-threatening or leave severe neurological sequelae, such as ANE. Due to different brain injury mechanisms, specific early diagnosis and brain protection treatment for different complications are unclear or unanimous. Therefore, further classification and basic research are needed.
KeywordsBrainLesionsRisk FactorInfluenzaChildren
Grohskopf, L.A., Alyanak, E., Broder, K.R., Walter, E.B., Fry, A.M. and Jernigan, D.B. (2019) Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices-United States, 2019-20 Influenza Season. MMWR Recommendations and Reports, 68, 1-21. https://doi.org/10.15585/mmwr.rr6803a1
Jochems, S.P., Marcon, F., Carniel, B.F., Holloway, M., Mitsi, E., Smith, E., Gritzfeld, J.F., Solorzano, C., Reine, J., Pojar, S., et al. (2018) Inflammation Induced by Influenza Virus Impairs Human Innate Immune Control of Pneumococcus. Nature Immunology, 19, 1299-1308. https://doi.org/10.1038/s41590-018-0231-y
Azziz Baumgartner, E., Dao, C.N., Nasreen, S., Bhuiyan, M.U., Mah, E.M.S., Al Mamun, A., Sharker, M.A., Zaman, R.U., Cheng, P.Y., Klimov, A.I., et al. (2012) Seasonality, Timing, and Climate Drivers of Influenza Activity Worldwide. The Journal of Infectious Diseases, 206, 838-846. https://doi.org/10.1093/infdis/jis467
Centers for Disease C, Prevention (2010) Estimates of Deaths Associated with Seasonal Influenza-United States, 1976-2007. MMWR Morbidity and Mortality Weekly Report, 59, 1057-1062.
Wong, K.K., Jain, S., Blanton, L., Dhara, R., Brammer, L., Fry, A.M. and Finelli, L. (2013) Influenza-Associated Pediatric Deaths in the United States, 2004-2012. Pediatrics, 132, 796-804. https://doi.org/10.1542/peds.2013-1493
Taubenberger, J.K., Reid, A.H., Krafft, A.E., Bijwaard, K.E. and Fanning, T.G. (1997) Initial Genetic Characterization of the 1918 “Spanish” Influenza Virus. Science, 275, 1793-1796. https://doi.org/10.1126/science.275.5307.1793
Schotsaert, M. and Garcia-Sastre, A. (2016) A High-Resolution Look at Influenza Virus Antigenic Drift. The Journal of Infectious Diseases, 214, 982. https://doi.org/10.1093/infdis/jiw183
Shah, S., Keil, A., Gara, K. and Nagarajan, L. (2014) Neurologic Complications of Influenza. Journal of Child Neurology, 29, NP49-NP53. https://doi.org/10.1177/0883073813499610
Surtees, R. and DeSousa, C. (2006) Influenza Virus Associated Encephalopathy. Archives of Disease in Childhood, 91, 455-456. https://doi.org/10.1136/adc.2005.092890
Amin, R., Ford-Jones, E., Richardson, S.E., MacGregor, D., Tellier, R., Heurter, H., Fearon, M. and Bitnun, A. (2008) Acute Childhood Encephalitis and Encephalopathy Associated with Influenza: A Prospective 11-Year Review. The Pediatric Infectious Disease Journal, 27, 390-395. https://doi.org/10.1097/INF.0b013e31816507b2
Hayase, Y. and Tobita, K. (1997) Influenza Virus and Neurological Diseases. Psychiatry and Clinical Neurosciences, 51, 181-184. https://doi.org/10.1111/j.1440-1819.1997.tb02580.x
Fujimoto, S., Kobayashi, M., Uemura, O., Iwasa, M., Ando, T., Katoh, T., Nakamura, C., Maki, N., Togari, H. and Wada, Y. (1998) PCR on Cerebrospinal Fluid to Show Influenza-Associated Acute Encephalopathy or Encephalitis. The Lancet, 352, 873-875. https://doi.org/10.1016/S0140-6736(98)12449-2
Taniguchi, D., Nakajima, S., Hayashida, A., Kuroki, T., Eguchi, H., Machida, Y., Hattori, N. and Miwa, H. (2017) Deep Cerebral Venous Thrombosis Mimicking Influenza-Associated Acute Necrotizing Encephalopathy: A Case Report. Journal of Medical Case Reports, 11, 281. https://doi.org/10.1186/s13256-017-1444-7
Togashi, T., Matsuzono, Y., Narita, M. and Morishima, T. (2004) Influenza-Associated Acute Encephalopathy in Japanese Children in 1994-2002. Virus Research, 103, 75-78. https://doi.org/10.1016/j.virusres.2004.02.016
Howard, A., Uyeki, T.M. and Fergie, J. (2018) Influenza-Associated Acute Necrotizing Encephalopathy in Siblings. Journal of the Pediatric Infectious Diseases Society, 7, e172-e177. https://doi.org/10.1093/jpids/piy033
Mizuguchi, M., Abe, J., Mikkaichi, K., Noma, S., Yoshida, K., Yamanaka, T. and Kamoshita, S. (1995) Acute Necrotising Encephalopathy of Childhood: A New Syndrome Presenting with Multifocal, Symmetric Brain Lesions. Journal of Neurology, Neurosurgery, and Psychiatry, 58, 555-561. https://doi.org/10.1136/jnnp.58.5.555
Mastrolia, M.V., Rubino, C., Resti, M., Trapani, S. and Galli, L. (2019) Characteristics and Outcome of Influenza-Associated Encephalopathy/Encephalitis among Children in a Tertiary Pediatric Hospital in Italy, 2017-2019. BMC Infectious Diseases, 19, 1012. https://doi.org/10.1186/s12879-019-4636-5
Sugaya, N. (2002) Influenza-Associated Encephalopathy in Japan. Seminars in Pediatric Infectious Diseases, 13, 79-84. https://doi.org/10.1053/spid.2002.122993
Tokunaga, Y., Kira, R., Takemoto, M., Gondo, K., Ishioka, H., Mihara, F. and Hara, T. (2000) Diagnostic Usefulness of Diffusion-Weighted Magnetic Resonance Imaging in Influenza-Associated Acute Encephalopathy or Encephalitis. Brain & Development, 22, 451-453. https://doi.org/10.1016/S0387-7604(00)00179-0
Dadak, M., Pul, R., Lanfermann, H., Hartmann, H., Hehr, U., Donnerstag, F., Michels, D. and Tryc, A.B. (2019) Varying Patterns of CNS Imaging in Influenza A Encephalopathy in Childhood. Clinical Neuroradiology. https://doi.org/10.1007/s00062-018-0756-3
Abenhaim Halpern, L., Agyeman, P., Steinlin, M., El-Koussy, M. and Grunt, S. (2013) Mild Encephalopathy with Splenial Lesion and Parainfluenza Virus Infection. Pediatric Neurology, 48, 252-254. https://doi.org/10.1016/j.pediatrneurol.2012.11.007
Kimura, S., Ohtuki, N., Nezu, A., Tanaka, M. and Takeshita, S. (1998) Clinical and Radiological Variability of Influenza-Related Encephalopathy or Encephalitis. Acta paediatrica Japonica: Overseas Edition, 40, 264-270. https://doi.org/10.1111/j.1442-200X.1998.tb01925.x
Sato, T. and Moriuchi, H. (2010) [Influenza-Associated Encephalopathy]. Nihon Rinsho Japanese Journal of Clinical Medicine, 68, 1661-1665.
Shiomi, M. (2011) [Pathogenesis of Acute Encephalitis and Acute Encephalopathy]. Nihon Rinsho Japanese Journal of Clinical Medicine, 69, 399-408.
Tachibana, M., Mohri, I., Hirata, I., Kuwada, A., Kimura-Ohba, S., Kagitani-Shimono, K., Fushimi, H., Inoue, T., Shiomi, M., Kakuta, Y., et al. (2019) Clasmatodendrosis Is Associated with Dendritic Spines and Does Not Represent Autophagic Astrocyte Death in Influenza-Associated Encephalopathy. Brain & Development, 41, 85-95. https://doi.org/10.1016/j.braindev.2018.07.008
Macdonald-Laurs, E., Koirala, A., Britton, P.N., Rawlinson, W., Hiew, C.C., McRae, J., Dale, R.C., Jones, C., Macartney, K., McMullan, B., et al. (2019) CSF Neopterin, a Useful Biomarker in Children Presenting with Influenza Associated Encephalopathy? European Journal of Paediatric Neurology: EJPN: Official Journal of the European Paediatric Neurology Society, 23, 204-213. https://doi.org/10.1016/j.ejpn.2018.09.009
Sejvar, J.J., Kohl, K.S., Bilynsky, R., Blumberg, D., Cvetkovich, T., Galama, J., Gidudu, J., Katikaneni, L., Khuri-Bulos, N., Oleske, J., et al. (2007) Encephalitis, Myelitis, and Acute Disseminated Encephalomyelitis (ADEM): Case Definitions and Guidelines for Collection, Analysis, and Presentation of Immunization Safety Data. Vaccine, 25, 5771-5792. https://doi.org/10.1016/j.vaccine.2007.04.060
Centers for Disease C, Prevention (2009) Neurologic Complications Associated with Novel Influenza A (H1N1) Virus Infection in Children-Dallas, Texas, May 2009. MMWR Morbidity and Mortality Weekly Report, 58, 773-778.
Britton, P.N., Dale, R.C., Blyth, C.C., Macartney, K., Crawford, N.W., Marshall, H., Clark, J.E., Elliott, E.J., Webster, R.I., Cheng, A.C., et al. (2017) Influenza-Associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015. The Pediatric Infectious Disease Journal, 36, 1021-1026. https://doi.org/10.1097/INF.0000000000001650
Yamada, S., Yasui, K., Hasegawa, Y., Tsuzuki, T., Yoshida, M. and Hashidume, Y. (2012) [An Autopsy Case of Pandemic (H1N1) 2009 Influenza Virus-Associated Encephalopathy]. Rinsho Shinkeigaku/Clinical Neurology, 52, 480-485. https://doi.org/10.5692/clinicalneurol.52.480
Yoshimura, H., Imai, Y., Beppu, M., Ohara, N., Kobayashi, J., Kuzuya, A., Yamagami, H., Kawamoto, M. and Kohara, N. (2008) [Elderly Autopsy Case of Influenza-Associated Encephalopathy]. Rinsho Shinkeigaku/Clinical Neurology, 48, 713-720. https://doi.org/10.5692/clinicalneurol.48.713
Sun, G., Ota, C., Kitaoka, S., Chiba, Y., Takayanagi, M., Kitamura, T., Yamamoto, K., Fujie, H., Mikami, H., Uematsu, M., et al. (2015) Elevated Serum Levels of Neutrophil Elastase in Patients with Influenza Virus-Associated Encephalopathy. Journal of the Neurological Sciences, 349, 190-195. https://doi.org/10.1016/j.jns.2015.01.017
Hosoya, M., Nunoi, H., Aoyama, M., Kawasaki, Y. and Suzuki, H. (2005) Cytochrome C and Tumor Necrosis Factor-Alpha Values in Serum and Cerebrospinal Fluid of Patients with Influenza-Associated Encephalopathy. Pediatric Infectious Disease Journal, 24, 467-470. https://doi.org/10.1097/01.inf.0000160995.07461.b8
Weitkamp, J.H., Spring, M.D., Brogan, T., Moses, H., Bloch, K.C. and Wright, P.F. (2004) Influenza a Virus-Associated Acute Necrotizing Encephalopathy in the United States. The Pediatric Infectious Disease Journal, 23, 259-263. https://doi.org/10.1097/01.inf.0000115631.99896.41
Kondrich, J. and Rosenthal, M. (2017) Influenza in Children. Current Opinion in Pediatrics, 29, 297-302. https://doi.org/10.1097/MOP.0000000000000495
Kirat, N., De Cauwer, H., Ceulemans, B., Vanneste, D. and Rossi, A. (2018) Influenza-Associated Encephalopathy with Extensive Reversible Restricted Diffusion within the White Matter. Acta Neurologica Belgica, 118, 553-555. https://doi.org/10.1007/s13760-018-1004-y
Mizuguchi, M., Hayashi, M., Nakano, I., Kuwashima, M., Yoshida, K., Nakai, Y., Itoh, M. and Takashima, S. (2002) Concentric Structure of Thalamic Lesions in Acute Necrotizing Encephalopathy. Neuroradiology, 44, 489-493. https://doi.org/10.1007/s00234-002-0773-3
Ormitti, F., Ventura, E., Summa, A., Picetti, E. and Crisi, G. (2010) Acute Necrotizing Encephalopathy in a Child during the 2009 Influenza A(H1N1) Pandemia: MR Imaging in Diagnosis and Follow-up. AJNR American Journal of Neuroradiology, 31, 396-400. https://doi.org/10.3174/ajnr.A2058
Goo, H.W., Choi, C.G., Yoon, C.H. and Ko, T.S. (2003) Acute Necrotizing Encephalopathy: Diffusion MR Imaging and Localized Proton MR Spectroscopic Findings in Two Infants. Korean Journal of Radiology, 4, 61-65. https://doi.org/10.3348/kjr.2003.4.1.61
Neilson, D.E. (2010) The Interplay of Infection and Genetics in Acute Necrotizing Encephalopathy. Current Opinion in Pediatrics, 22, 751-757. https://doi.org/10.1097/MOP.0b013e3283402bfe
Okumura, A., Mizuguchi, M., Kidokoro, H., Tanaka, M., Abe, S., Hosoya, M., Aiba, H., Maegaki, Y., Yamamoto, H., Tanabe, T., et al. (2009) Outcome of Acute Necrotizing Encephalopathy in Relation to Treatment with Corticosteroids and Gammaglobulin. Brain & Development, 31, 221-227. https://doi.org/10.1016/j.braindev.2008.03.005
Wolkewitz, M. and Schumacher, M. (2016) Neuraminidase Inhibitors and Hospital Mortality in British Patients with H1N1 Influenza A: A Re-Analysis of Observational Data. PLoS ONE, 11, e0160430. https://doi.org/10.1371/journal.pone.0160430
Ichiyama, T., Morishima, T., Suenaga, N., Kajimoto, M., Matsubara, T. and Furukawa, S. (2005) Analysis of Serum Soluble CD40 Ligand in Patients with Influenza Virus-Associated Encephalopathy. Journal of the Neurological Sciences, 239, 53-57. https://doi.org/10.1016/j.jns.2005.07.010
Ichiyama, T., Morishima, T., Isumi, H., Matsufuji, H., Matsubara, T. and Furukawa, S. (2004) Analysis of Cytokine Levels and NF-kappaB Activation in Peripheral Blood Mononuclear Cells in Influenza Virus-Associated Encephalopathy. Cytokine, 27, 31-37. https://doi.org/10.1016/j.cyto.2004.03.012
Nara, A., Nagai, H., Yamaguchi, R., Yoshida, K., Iwase, H. and Mizuguchi, M. (2015) An Unusual Autopsy Case of Cytokine Storm-Derived Influenza-Associated Encephalopathy without Typical Histopathological Findings: Autopsy Case Report. American Journal of Forensic Medicine and Pathology, 36, 3-5. https://doi.org/10.1097/PAF.0000000000000129
Ichiyama, T., Endo, S., Kaneko, M., Isumi, H., Matsubara, T. and Furukawa, S. (2003) Serum Cytokine Concentrations of Influenza-Associated Acute Necrotizing Encephalopathy. Pediatrics International, 45, 734-736. https://doi.org/10.1111/j.1442-200X.2003.01822.x
Brown, G.C. and Borutaite, V. (2008) Regulation of Apoptosis by the Redox State of Cytochrome C. Biochimica et Biophysica Acta, 1777, 877-881. https://doi.org/10.1016/j.bbabio.2008.03.024
Yamanaka, G., Kawashima, H., Suganami, Y., Watanabe, C., Watanabe, Y., Miyajima, T., Takekuma, K., Oguchi, S. and Hoshika, A. (2006) Diagnostic and Predictive Value of CSF d-ROM Level in Influenza Virus-Associated Encephalopathy. Journal of the Neurological Sciences, 243, 71-75. https://doi.org/10.1016/j.jns.2005.11.029
Franke, R.P., Fuhrmann, R., Mrowietz, C., Rickert, D., Hiebl, B. and Jung, F. (2010) Reduced Diagnostic Value of Lactate Dehydrogenase (LDH) in the Presence of Radiographic Contrast Media. Clinical Hemorheology and Microcirculation, 45, 123-130. https://doi.org/10.3233/CH-2010-1290
Studahl, M. (2003) Influenza Virus and CNS Manifestations. Journal of Clinical Virology: The Official Publication of the Pan American Society for Clinical Virology, 28, 225-232. https://doi.org/10.1016/S1386-6532(03)00119-7
Asai, H., Kakita, H., Aoyama, M., Nagaya, Y., Saitoh, S. and Asai, K. (2013) Diclofenac Enhances Proinflammatory Cytokine-Induced Aquaporin-4 Expression in Cultured Astrocyte. Cellular and Molecular Neurobiology, 33, 393-400. https://doi.org/10.1007/s10571-013-9905-z
Chen, Q., Liu, Y., Lu, A., Ni, K., Xiang, Z., Wen, K. and Tu, W. (2017) Influenza Virus Infection Exacerbates Experimental Autoimmune Encephalomyelitis Disease by Promoting Type I T Cells Infiltration into Central Nervous System. Journal of Autoimmunity, 77, 1-10. https://doi.org/10.1016/j.jaut.2016.10.006
Stoeck, K. and Zerr, I. (2011) Cellular Immune Activation Markers Neopterin and Beta2-Microglobulin Are Not Elevated in the Cerebrospinal Fluid of Patients with Creutzfeldt-Jakob Disease. Journal of Neuroimmunology, 233, 228-232. https://doi.org/10.1016/j.jneuroim.2010.12.003
Pranzatelli, M.R., Hyland, K., Tate, E.D., Arnold, L.A., Allison, T.J. and Soori, G.S. (2004) Evidence of Cellular Immune Activation in Children with Opsoclonus-Myoclonus: Cerebrospinal Fluid Neopterin. Journal of Child Neurology, 19, 919-924. https://doi.org/10.1177/08830738040190120201
Nakai, Y., Itoh, M., Mizuguchi, M., Ozawa, H., Okazaki, E., Kobayashi, Y., Takahashi, M., Ohtani, K., Ogawa, A., Narita, M., et al. (2003) Apoptosis and Microglial Activation in Influenza Encephalopathy. Acta Neuropathologica, 105, 233-239. https://doi.org/10.1007/s00401-002-0605-x
Takahashi, M, Yamada, T., Nakashita, Y., Saikusa, H., Deguchi, M., Kida, H., Tashiro, M. and Toyoda, T. (2000) Influenza Virus-Induced Encephalopathy: Clinicopathologic Study of an Autopsied Case. Pediatrics International, 42, 204-214. https://doi.org/10.1046/j.1442-200x.2000.01203.x
Morichi, S., Morishita, N., Takeshita, M., Ishida, Y., Oana, S., Yamanaka, G., Kashiwagi, Y. and Kawashima, H. (2017) Vascular Endothelial Growth Factor (VEGF) and Platelet-Derived Growth Factor (PDGF) Levels in the Cerebrospinal Fluid of Children with Influenza-Associated Encephalopathy. Journal of Infection and Chemotherapy, 23, 80-84. https://doi.org/10.1016/j.jiac.2016.10.007
Ishige, T., Igarashi, Y., Hatori, R., Tatsuki, M., Sasahara, Y., Takizawa, T. and Arakawa, H. (2018) IL-10RA Mutation as a Risk Factor of Severe Influenza-Associated Encephalopathy: A Case Report. Pediatrics, 141, e20173548. https://doi.org/10.1542/peds.2017-3548
Funato, T., Kozawa, K. and Kaku, M. (2002) [Relationship of Polymorphism in CYP2C9 to Genetic Susceptibility to Diclofenac-Induced Influenza-Virus-Associated Encephalopathy]. The Japanese Journal of Clinical Pathology, 50, 140-145.
Dicky, O., Cheuret, E. and Berthomieu, L. (2014) [Severe Neurological Forms of Influenza in Children: Report on Three Cases of Severe Encephalitis in France]. Archives de Pédiatrie, 21, 514-517. https://doi.org/10.1016/j.arcped.2014.02.015
Hinson, V.K. and Tyor, W.R. (2001) Update on Viral Encephalitis. Current Opinion in Neurology, 14, 369-374. https://doi.org/10.1097/00019052-200106000-00017
Venkatesan, A., Tunkel, A.R., Bloch, K.C., Lauring, A.S., Sejvar, J., Bitnun, A., Stahl, J.P., Mailles, A., Drebot, M., Rupprecht, C.E., et al. (2013) Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: Consensus Statement of the International Encephalitis Consortium. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 57, 1114-1128. https://doi.org/10.1093/cid/cit458
Cherry, J.D., Harrison, G.J. and Kaplan, S.L. (2014) Feigin and Cherry’s Textbook of Pediatric Infectious Diseases.
Tunkel, A.R., Glaser, C.A., Bloch, K.C., Sejvar, J.J., Marra, C.M., Roos, K.L., Hartman, B.J., Kaplan, S.L., Scheld, W.M., Whitley, R.J., et al. (2008) The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 47, 303-327. https://doi.org/10.1086/589747
Kawano, G., Iwata, O., Iwata, S., Kawano, K., Obu, K., Kuki, I., Rinka, H., Shiomi, M., Yamanouchi, H., Kakuma, T., et al. (2011) Determinants of Outcomes Following Acute Child Encephalopathy and Encephalitis: Pivotal Effect of Early and Delayed Cooling. Archives of Disease in Childhood, 96, 936-941. https://doi.org/10.1136/adc.2009.180554
Michaeli, O., Kassis, I., Shachor-Meyouhas, Y., Shahar, E. and Ravid, S. (2014) Long-Term Motor and Cognitive Outcome of Acute Encephalitis. Pediatrics, 133, e546-e552. https://doi.org/10.1542/peds.2013-3010
Fowler, A., Stodberg, T., Eriksson, M. and Wickstrom, R. (2010) Long-Term Outcomes of Acute Encephalitis in Childhood. Pediatrics, 126, e828-e835. https://doi.org/10.1542/peds.2009-3188
Takanashi, J., Tada, H., Kuroki, H. and Barkovich, A.J. (2009) Delirious Behavior in Influenza Is Associated with a Reversible Splenial Lesion. Brain & Development, 31, 423-426. https://doi.org/10.1016/j.braindev.2008.07.013
Okuno, H., Yahata, Y., Tanaka-Taya, K., Arai, S., Satoh, H., Morino, S., Shimada, T., Sunagawa, T., Uyeki, T.M. and Oishi, K. (2018) Characteristics and Outcomes of Influenza-Associated Encephalopathy Cases Among Children and Adults in Japan, 2010-2015. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 66, 1831-1837. https://doi.org/10.1093/cid/cix1126
Takanashi, J., Takahashi, Y., Imamura, A., Kodama, K., Watanabe, A., Tominaga, K., Muramatsu, K. and Barkovich, A.J. (2012) Late Delirious Behavior with 2009 H1N1 Influenza: Mild Autoimmune-Mediated Encephalitis? Pediatrics, 129, e1068-e1071. https://doi.org/10.1542/peds.2010-3221
Utumi, Y., Iseki, E., Murayama, N., Ichimiya, Y. and Arai, H. (2010) [Limbic Encephalitis Caused by Herpes Simplex Virus Infection after Vaccination against the Influenza Virus]. Brain and Nerves, 62, 615-619.
Thampi, N., Bitnun, A., Banner, D., Rowe, T., Kelvin, D.J., Richardson, S.E., Parkin, P. and Tran, D. (2011) Influenza-Associated Encephalopathy with Elevated Antibody Titers to Pandemic (H1N1) 2009 Influenza. Journal of Child Neurology, 26, 501-506. https://doi.org/10.1177/0883073810381128
Nakamura, Y., Ikeda, K., Yoshii, Y., Ito, H., Hirayama, T., Kawabe, K., Kano, O. and Iwasaki, Y. (2011) Influenza-Associated Monophasic Neuromyelitis Optica. Internal Medicine, 50, 1605-1609. https://doi.org/10.2169/internalmedicine.50.5027
Blackmore, S., Hernandez, J., Juda, M., Ryder, E., Freund, G.G., Johnson, R.W. and Steelman, A.J. (2017) Influenza Infection Triggers Disease in a Genetic Model of Experimental Autoimmune Encephalomyelitis. Proceedings of the National Academy of Sciences of the United States of America, 114, E6107-E6116. https://doi.org/10.1073/pnas.1620415114
Muller, R.B., Maier, R., Hoschler, K., Zambon, M., Ludewig, B., Herrmann, M., Schulze-Koops, H. and von Kempis, J. (2013) Efficient Boosting of the Antiviral T Cell Response in B Cell-Depleted Patients with Autoimmune Rheumatic Diseases Following Influenza Vaccination. Clinical and Experimental Rheumatology, 31, 723-730.
Amano, H., Miyamoto, N., Shimura, H., Sato, D.K., Fujihara, K., Ueno, S., Nakamura, R., Ueno, Y., Watanabe, M., Hattori, N., et al. (2014) Influenza-Associated MOG Antibody-Positive Longitudinally Extensive Transverse Myelitis: A Case Report. BMC Neurology, 14, 224. https://doi.org/10.1186/s12883-014-0224-x
Puig-Barbera, J., Diez-Domingo, J., Varea, A.B., Chavarri, G.S., Rodrigo, J.A., Hoyos, S.P. and Vidal, D.G. (2007) Effectiveness of MF59-Adjuvanted Subunit Influenza Vaccine in Preventing Hospitalisations for Cardiovascular Disease, Cerebrovascular Disease and Pneumonia in the Elderly. Vaccine, 25, 7313-7321. https://doi.org/10.1016/j.vaccine.2007.08.039
Lavallee, P., Perchaud, V., Gautier-Bertrand, M., Grabli, D. and Amarenco, P. (2002) Association between Influenza Vaccination and Reduced Risk of Brain Infarction. Stroke, 33, 513-518. https://doi.org/10.1161/hs0202.102328
Carels, T. and Flamaing, J. (2005) [Vaccination of the Elderly: An Update]. Tijdschrift voor Gerontologie en Geriatrie, 36, 203-208. https://doi.org/10.1007/BF03074734
Al Shibli, A., Alkuwaiti, N., Hamie, M., Abukhater, D., Noureddin, M.B., Amri, A., Al Kaabi, S., Al Kaabi, A., Harbi, M. and Narchi, H. (2017) Significance of Platelet Count in Children Admitted with Bronchiolitis. World Journal of Clinical Pediatrics, 6, 118-123. https://doi.org/10.5409/wjcp.v6.i2.118
Bartynski, W.S., Upadhyaya, A.R. and Boardman, J.F. (2009) Posterior Reversible Encephalopathy Syndrome and Cerebral Vasculopathy Associated with Influenza A Infection: Report of a Case and Review of the Literature. Journal of Computer Assisted Tomography, 33, 917-922. https://doi.org/10.1097/RCT.0b013e3181993a43
Chow, F.C., Edlow, B.L., Frosch, M.P., Copen, W.A. and Greer, D.M. (2011) Outcome in Patients with H1N1 Influenza and Cerebrovascular Injury Treated with Extracorporeal Membrane Oxygenation. Neurocritical Care, 15, 156-160. https://doi.org/10.1007/s12028-011-9534-7