Other / General Medicine
Eduardo A. Acevedo-Rosario, MD
Resident Physician
Memorial Hospital System
Fort Lauderdale, Florida, United States
John Paul Mauriello, DO
Resident Physician PGY-3
Memorial Healthcare System
Dania Beach, Florida, United States
Ian Miller, DO
Attending Physician
Memorial Healthcare System
Hollywood, Florida, United States
Eduardo A. Acevedo-Rosario, MD
Resident Physician
Memorial Hospital System
Fort Lauderdale, Florida, United States
A 43-year-old previously healthy male presented with tremors, altered mental status, fever, and tachycardia. Initial CT brain, metabolic, and toxic panels were negative. CSF was remarkable for mild elevation in WBC, and Influenza B PCR was positive, suggestive of possible viral meningoencephalitis. CT chest showed bibasilar pneumonia, also likely secondary to influenza B. Patient quickly decompensated, developing worsening mental status, agitation, and respiratory failure requiring intubation and sedation. After eventual stabilization and extubation, patient remained encephalopathic with ataxia, dysarthria, dysphagia (requiring PEG tube) and cognitive deficits. He was then transferred to acute rehabilitation, where he showed significant improvement in function and cognition. Upon discharge patient was performing his activities of daily living with modified independence to supervision, ambulating with a rolling walker, tolerating a regular diet with thin liquids and with significant improvement in memory, cognition and problem solving.
Influenza is a rare cause of encephalopathy with epidemiologic studies reporting about 2.8 cases per 1,000,000 children and 0.98 per 1,000,000 adults. Main signs and symptoms in adults include acute onset altered mental status, delirious behavior, cognitive dysfunction, and seizures; often without definitive neuroimaging or CSF findings. Early rehabilitation strategies are key to the recovery of these patients. Strategies include a multidisciplinary approach to minimize deconditioning, promote neuroplasticity, and support cognitive retraining.
Although influenza remains widespread and recurrent, influenza-associated encephalopathy remains rare and underrecognized in adults. This case highlights the critical role of rehabilitation in managing post-viral encephalopathy and associated deconditioning. Early rehabilitation can significantly improve outcomes and quality of life in encephalopathic patients. Given influenza’s global prevalence, PM&R specialists must remain vigilant for post-viral cognitive and physical impairments, ensuring timely interventions that optimize recovery to reduce long-term disability.
