{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T06:10:12Z","timestamp":1765174212991,"version":"3.46.0"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,21]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Acute necrotising encephalopathy (ANE) of childhood is a rare, rapidly progressive and often fatal form of encephalopathy characterised by distinctive clinical and neuroradiological features. It typically presents with a sudden and progressive alteration of consciousness, along with the characteristic finding of multifocal, symmetric lesions involving the thalami, brainstem, cerebellum and cerebral white matter. Although its exact pathogenesis remains unclear, it is thought to result from a cytokine storm triggered by viral infections, leading to blood\u2013brain barrier disruption and brain injury. There is currently limited evidence on optimal treatment and no established consensus to standardise management. This case series presents three paediatric cases of influenza A-associated ANE, all of whom initially exhibited mild neurological symptoms but rapidly deteriorated to coma and death. These cases highlight the urgent need for further research and the development of standardised treatment guidelines for this severe and under-recognised condition.<\/jats:p>","DOI":"10.1136\/bcr-2025-268934","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T06:05:17Z","timestamp":1765173917000},"page":"e268934","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute necrotising encephalopathy (ANE) due to influenza: an unrecognised encephalopathy in childhood"],"prefix":"10.1136","volume":"18","author":[{"given":"Alyaa","family":"Al Ali","sequence":"first","affiliation":[{"name":"Paediatric Critical Care Medicine, Shaikh Khalifa Medical City, Abu Dhabi, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatmah","family":"Al Zeyoudi","sequence":"additional","affiliation":[{"name":"Radiology, Shaikh Khalifa Medical City, Abu Dhabi, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Musaab","family":"Ramsi","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care, Shaikh Khalifa Medical City, Abu Dhabi, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,7]]},"reference":[{"key":"2025120722051236000_18.12.e268934.1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jpeds.2021.06.075","article-title":"Prevalence, Risk Factors, and Outcomes of Influenza-Associated Neurologic Complications in Children","volume":"239","author":"Antoon","year":"2021","journal-title":"J Pediatr"},{"key":"2025120722051236000_18.12.e268934.2","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1097\/INF.0000000000002686","article-title":"Neurologic Complications in Children Hospitalized With Influenza Infections","volume":"39","author":"Sol\u00eds-Garc\u00eda","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"2025120722051236000_18.12.e268934.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-008-0823-z"},{"key":"2025120722051236000_18.12.e268934.4","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.58.5.555"},{"key":"2025120722051236000_18.12.e268934.5","first-page":"1","article-title":"Neurologic manifestations of influenza in children","volume":"5","author":"Robinson","year":"2020","journal-title":"J Assoc Med Microbiol Infect Dis Can"},{"key":"2025120722051236000_18.12.e268934.6","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s12028-012-9796-8","article-title":"Influenza-Associated Neurological Complications","volume":"18","author":"Tsai","year":"2013","journal-title":"Neurocrit Care"},{"key":"2025120722051236000_18.12.e268934.7","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.braindev.2008.03.005","article-title":"Outcome of acute necrotizing encephalopathy in relation to treatment with corticosteroids and gammaglobulin","volume":"31","author":"Okumura","year":"2009","journal-title":"Brain and Development"},{"key":"2025120722051236000_18.12.e268934.8","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-021-03659-6","article-title":"Infectious disease-associated encephalopathies","volume":"25","author":"Barbosa-Silva","year":"2021","journal-title":"Crit Care"},{"key":"2025120722051236000_18.12.e268934.9","article-title":"Early High-Dose Methylprednisolone Therapy Is Associated with Better Outcomes in Children with Acute Necrotizing Encephalopathy","volume":"9","author":"Chang","year":"2022","journal-title":"Children (Basel)"},{"key":"2025120722051236000_18.12.e268934.10","doi-asserted-by":"crossref","unstructured":"Mastrolia MV , Rubino C , Resti M , et al . Characteristics and outcome of influenza-associated encephalopathy\/encephalitis among children in a tertiary pediatric hospital in Italy, 2017\u20132019. 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