Acute hemorrhagic leukoencephalopathy and influenza a (H1N1) virus

How to cite this article:
Wiwanitkit S, Wiwanitkit V. Acute hemorrhagic leukoencephalopathy and influenza a (H1N1) virus. Ann Trop Med Public Health 2013;6:688-9


How to cite this URL:
Wiwanitkit S, Wiwanitkit V. Acute hemorrhagic leukoencephalopathy and influenza a (H1N1) virus. Ann Trop Med Public Health [serial online] 2013 [cited 2021 Mar 4];6:688-9. Available from:

Dear Sir,

The neurological complication due to influenza A (H1N1) virus infection is very interesting. “Acute hemorrhagic leukoencephalopathy” is very interesting, rare complication. [1] Jeganathan et al. recently reported this rare complication of H1N1 influenza infection in Neuro Critical Care and mentioned that “this is the first published case of AHLE in association with H1N1 that has been confirmed pathologically.” [1] In fact, the neurological complication of H1N1 influenza infection can be seen, and the acute hemorrhagic encephalopathy is an extremely rare complication. Nevertheless, the case report seems not to be the first documented case. Gordon et al. already reported another case. [2] In that report, a fatal case of 26-years-old female patient with H1N1 influenza was reported. [2] The autopsy report in this case confirmed for acute hemorrhagic leukoencephalopathy. [2] This neurological condition is features as a brain pathology with brain edema, demyelination of white matter, and neurovasculitis.

Focusing on the diagnosis of this condition, it should be aware in any cases with influenza infection and present with these signs and symptoms: a) severe headache, b) agitation and deterioration of consciousness, c) focal neurological deficit that can abruptly progress to loss of consciousness, and d) respiratory difficulty that might need intubation. However, these clinical features might be difficult to observe in cases of severe influenza with respiratory distress. Using CT brain might give some clues as edema of brain, especially at thalamus and posterior brain. For treatment, immunosuppressive agents and plasmapheresis is mentioned for its ability to prevent rapid progression and death. [1] Nevertheless, the disease is usually late diagnosis, and most cases are fatal. [1],[2] In the era of emerging influenza, this severe neurological complication of influenza should be kept in mind of practitioner to early management of the patients.



1. Jeganathan N, Fox M, Schneider J, Gurka D, Bleck T. Acute Hemorrhagic Leukoencephalopathy Associated with Influenza A (H1N1) Virus. Neurocrit Care 2013;19:218-21.
2. Gordon J, Kinder BW, Turner K, Pina E, Rashkin M. Post Viral Acute Hemorrhagic Leukoencephalopathy Associated With H1N1 Strain Influenza. First published online as doi:10.1164/ajrccm-conference.2010.181.1_MeetingAbstracts.A6126. Available from: [Last accessed on 2014 February 28].

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.140277

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