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Bithalamic compromise in acute disseminated encephalomyelitis following H1N1 influenza vaccine

Comprometimento bitalâmico na encefalomielite aguda disseminada após vacina H1N1

IMAGES IN NEUROLOGY

Bithalamic compromise in acute disseminated encephalomyelitis following H1N1 influenza vaccine

Comprometimento bitalâmico na encefalomielite aguda disseminada após vacina H1N1

Artur Furlaneto FernandesI; Paulo Eurípedes MarchioriII

INeurologist, Hospital de Clínicas, University of São Paulo, São Paulo SP, Brazil

IIAssociated Professor of Neurology, Hospital de Clínicas, University of São Paulo, São Paulo SP, Brazil

Correspondence Correspondence: Paulo Eurípedes Marchiori Av. Dr. Enéas Carvalho Aguiar 255 / 5° andar 05403-000 São Paulo SP - Brasil E-mail: marchiori@hcnet.usp.br

A 5- year-old boy was admitted with history of fever, nausea, vomiting and somnolence which had started two days after H1N1 influenza vaccination. Neurological ex-amination showed mild gait ataxia, vertical ophthalmo-paresis and brisk deep tendon reflexes. Brain MRI re-vealed right frontal and bilateral thalamic lesions with increased signal in T2-weighted and flair images (Figs A, B, C, D). Cerebrospinal fluid analysis showed mild lym-phocytic pleocytosis. The patient had a marked clinical improvement after oral corticosteroids was commenced.


Bilateral thalamic lesions have been reported in 12% of pediatric patients with ADEM. This is the first case of ADEM following H1N1 vaccine reported in Brazil.

Received 4 July 2010

Received in final form 18 January 2011

Accepted 25 January 2011

  • 1
    Dardiotis E, Kountra P, Kapsalaki E, Protogerou G, Markopoulou K. Acute disseminated encephalomyelitis with bilateral thalamic necrosis. J Child Neurol 2009;24:1001-1004.
  • 2
    Tenembaum S, Chitnis T, Ness J, Hahn JS. Acute disseminated encephalo-myelitis. Neurology 2007;68(Suppl 2):S23-S36.
  • Correspondence:
    Paulo Eurípedes Marchiori
    Av. Dr. Enéas Carvalho Aguiar 255 / 5° andar
    05403-000 São Paulo SP - Brasil
    E-mail:
  • Publication Dates

    • Publication in this collection
      19 July 2012
    • Date of issue
      June 2011
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