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Acute necrotizing encephalitis of childhood

Case contributed by Ahmed Abdrabou
Diagnosis almost certain

Presentation

Vomiting, high-grade fever and diarrhea 3 days ago followed by lethargy and single episode of seizure.

Patient Data

Age: 2 years
Gender: Female

Bilateral symmetrical ill-defined hypodense lesions at both thalami with no significant mass effect or midline shift. 

Bilateral, rather symmetrical abnormal signal intensities are noted in both thalami, as well as the deep white matter of frontal and parietal lobes on both sides. The dorsal pons is possibly involved. These lesions present diffusion restriction on DWI (verified on the ADC map), bright signal on T2WI/FLAIR and low signal on T1WI, with foci of hemosiderin deposition within the center of thalamic lesions seen on GRE images, consistent with previous hemorrhage. No post-contrast enhancement, significant mass effect or midline shift.

Case Discussion

The constellation of findings is in keeping with acute necrotizing encephalitis of childhood. Lumbar puncture was negative. The patient received IV antibiotics, antiepileptic and corticosteroids and was discharged after improvement in his general condition.

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