Concomitant H1N1 encephalopathy and acute ischemic stroke: A case report

Neurological complications of infection by the novel H1N1 virus have been described primarily in children. In adults, patients typically present with fever and respiratory symptoms, and may develop acute respiratory distress syndrome, sepsis and stroke. We present a 45-year-old man whose presentation of aphasia and right hemiplegia were incongruent with the findings on MRI of a small acute ischemic stroke. He rapidly developed multi-organ failure and died. Nasal swab PCR obtained prior to death returned positive for influenza virus A/H1N1. At autopsy, a small acute hemorrhagic infarction in the left parietal lobe was present. We suspect that this was a cardio-embolic stroke, probably triggered by H1N1 myocarditis.