Acute necrotizing encephalitis

Case contributed by Abdulrahman Abdo Ali Abbas
Diagnosis almost certain


Acute onset of fever , diarrhea and recurrent attacks of convulsions

Patient Data

Age: 1 year
Gender: Female

Bilateral, rather symmetrical abnormal signal intensities are noted in both thalami, as well as the deep white matter of parietal lobes on both sides. The dentate nuclei also involved.

These lesions showed diffusion restriction on DWI, bright signal on T2WI/FLAIR, and low signal on T1WI, foci of blooming seen in the center of thalami on gradient sequence consistent with subacute hemorrhage.


Case Discussion

Acute necrotizing encephalopathy is a rare entity characterized by the typical involvement of bilateral thalami, involvement of cerebral and cerebellar hemispheres, internal/ external capsules, and brainstem is also seen with secondary hemorrhage. 

Acute Necrotizing Hemorrhagic Encephalopathy is reported in many cases of COVID-19 presented with altered mental status.


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