Acute necrotizing encephalopathy

Case contributed by Hoe Han Guan


Fever and upper respiratory tract symptoms for 4 days. Developed status epilepticus.

Patient Data

Age: 1 year
Gender: Male

Relatively symmetrical hypodensities in bilateral deep white matter of bilateral frontal lobes, posterior ends of bilateral lentiform nucleic, thalami, midbrain (especially tegmentum), pons, bilateral middle cerebellar peduncles and bilateral cerebellar white matters.

No acute intracranial hemorrhage.
No hydrocephalus. Basal cisterns are not effaced.
Normal variant of cavum septum pellucidum.

One week after the initial CT brain, patient had MRI brain performed.

Bilateral relatively symmetrical abnormal signal intensities involving white matter of both fronto-parietal lobes, posterior ends of both lentiform nucleic, thalami, both cerebral peduncle, tegmentum of midbrain, pons and both cerebellar white matters. These lesions demonstrate hyperintensities on T1WI, T2WI and FLAIR sequence. On GRE sequences, multiple foci of blooming artefacts noted within these lesions in keeping with subacute hemorrhage.

A few areas of restricted diffusion within these lesions on DWI/ADC map.

Case Discussion

These CT and MRI imaging features were in favor of acute necrotizing encephalopathy of childhood.

Nasopharyngeal aspirate of this patient was positive of respiratory Influenza A and B.

Acute necrotizing encephalitis of childhood is a rare encephalopathy where viral etiology has been proposed in some cases. Intracranial hemorrhage and cavitation are associated with worse prognosis.

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