y - JOUR A2 - Yegneswaran, Balaji AU - Edet, Angela AU - Ku, Katherine AU - Guzman, Irene AU - Dargham，她阿布PY - 2020 DA - 2020/12/22 TI -急性流感脑炎/脑病与流感相关的一分之一无能成人SP - 6616805六世- 2020 AB - 32岁的男性给急诊(ED)的排痰性咳嗽4天2天前表示和混乱。他有发热、心动过速和低血压。最初，实验室和流感A/B PCR进行。白细胞升高17.3，乳酸水平为3.1。他被给予一团生理盐水和广谱抗生素、头孢曲松和阿奇霉素。随后通过鼻腔快速抗原检测发现该患者A型流感呈阳性。住院第2天，患者精神状态和呼吸窘迫加重，需插管机械通气。头部CT无造影显示额顶叶深部白质对称低密度区。腰椎穿刺示白细胞轻度升高及轻度淋巴细胞增多。 Brain MRI without contrast revealed symmetric hyperintense T2 FLAIR signaling in the periventricular white matter and the splenium of the corpus callosum. He was found to have encephalitis secondary to influenza A and was started on a course of oseltamivir at higher doses of 150 mg BID for 2 weeks. On hospital day 10, after nine days of intubation, the patient received a tracheostomy due to failure to extubate and no improvement in mental status. He remained ventilator-dependent with little improvement in mental status; the patient was transferred to a long-term acute care hospital (LTACH) facility for further specialized care. He did not show any neurologic recovery or improvement in the three months after initial presentation of symptoms. In the fifth month after the initial symptoms, there was no recovery of preinsult neurologic function. The family had a palliative care meeting to discuss the plan and goals of care. It was decided by close family members that “compassionate extubation” would be done due to ongoing stress on the patient’s body physically and neurologically. This case illustrates the importance of prompt identification and treatment of influenza in the prevention of rapidly progressive sequelae. SN - 2090-6420 UR - https://doi.org/10.1155/2020/6616805 DO - 10.1155/2020/6616805 JF - Case Reports in Critical Care PB - Hindawi KW - ER -