Acute necrotizing encephalitis of childhood

Case contributed by Shalal Ali Ali Mohsen
Diagnosis certain


Recent history of upper respiratory tract infection, now presenting with convulsions and disturbed conscious level.

Patient Data

Age: 1 year
Gender: Male

​Bilateral thalamic swelling with areas of high T2W, heterogeneous and predominately high signal on T1W likely of hemorrhage, with restricted diffusion.

Other areas of similar abnormal signal are alsoseen at the left midbrain, splenium of the corpus callosum, bilateral frontal and parietal subcortical regions.

Follow-up post therapy


Regressive course of the size of the previously noted bilateral thalamic and cerebral cortical and subcortical patchy areas of altered MRI signal and the surrounding edema. The lesions show facilitated diffusion at the current study.

Case Discussion

The bilateral thalamic and cerebral lesions are typical of acute necrotizing encephalitis of childhood. The patient received medical treatment, mainly IV immunoglobulin, and showed significant regression of the disease clinically and on imaging . 

Other differential diagnoses could be acute disseminated encephalomyelitis (ADEM), which was excluded clinically by a short time gap (5 days) between upper respiratory tract infection and neurological manifestations. Also viral encephalitis which was excluded by lumbar puncture and culture.

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