Neurological manifestations of influenza infection in children and adults: Results of a National British Surveillance Study

Anu Goenka, Benedict D Michael, Elizabeth Ledger, Ian J Hart, Michael Absoud, Gabriel Chow, James Lilleker, Michael Lunn, David McKee, Deirdre Peake, Karen Pysden, Mark Roberts, Enitan D Carrol, Ming Lim, Shivaram Avula, Tom Solomon, Rachel Kneen

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The emergence of influenza A(H1N1) 2009 was met with increased reports of associated neurological manifestations. We aimed to describe neurological manifestations of influenza in adults and children in the United Kingdom that presented at this time.

METHODS: A 2-year surveillance study was undertaken through the British adult and pediatric neurological surveillance units from February 2011. Patients were included if they met clinical case definitions within 1 month of proven influenza infection.

RESULTS: Twenty-five cases were identified: 21 (84%) in children and 4 (16%) in adults. Six (29%) children had preexisting neurological disorders. Polymerase chain reaction of respiratory secretions identified influenza A in 21 (81%; 20 of which [95%] were H1N1) and influenza B in 4 (15%). Twelve children had encephalopathy (1 with movement disorder), 8 had encephalitis, and 1 had meningoencephalitis. Two adults had encephalopathy with movement disorder, 1 had encephalitis, and 1 had Guillain-Barré syndrome. Seven individuals (6 children) had specific acute encephalopathy syndromes (4 acute necrotizing encephalopathy, 1 acute infantile encephalopathy predominantly affecting the frontal lobes, 1 hemorrhagic shock and encephalopathy, 1 acute hemorrhagic leukoencephalopathy). Twenty (80%) required intensive care, 17 (68%) had poor outcome, and 4 (16%) died.

CONCLUSIONS: This surveillance study described a cohort of adults and children with neurological manifestations of influenza. The majority were due to H1N1. More children than adults were identified; many children had specific encephalopathy syndromes with poor outcomes. None had been vaccinated, although 8 (32%) had indications for this. A modified classification system is proposed based on our data and the increasing spectrum of recognized acute encephalopathy syndromes.

Original languageUndefined
Pages (from-to)775-784
Number of pages10
JournalClinical Infectious Diseases
Issue number6
Publication statusPublished - 18 Dec 2013


  • Adolescent
  • Adult
  • Brain
  • Central Nervous System Diseases
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Influenza A Virus, H1N1 Subtype
  • Influenza B virus
  • Influenza, Human
  • Male
  • Middle Aged
  • United Kingdom
  • Case Reports
  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this