Plain and contrast enhanced MRI brain of 10 year old child showed symmetrical T2 & FLAIR hyperintense and T1 hypointense signal lesions in bilateral thalami, posterior ends of bilateral lentiform nuclei, midbrain, pons, bilateral cerebellar hemispheres, bilateral high frontal lobes, bilateral cerebellar vermis and right periventricular temporal white matter. These lesions showed restricted diffusion and thin peripheral enhancement.
Foci of blooming were seen in thalamic and vermial lesions on gradient sequence.
Mass effect was seen with compression of 3rd and 4th ventricles with mild bilateral lateral ventricular dilatation. Bilateral cerebellar tonsillar herniation was present.
Overall imaging features were in favour of acute necrotising encephalopathy of childhood.