10-year-old child with a recent history of chickenpox presented with fever, multiple episodes of seizures and altered sensorium. Contrast enhanced MRI of the brain showed symmetrical T2 high signal intensity lesions in bilateral thalami, posterior ends of bilateral lentiform nuclei, brainstem, bilateral cerebellar hemispheres, bilateral high frontal and right periventricular white matter with restricted diffusion and peripheral enhancement.  Foci of hemorrhage are seen within thalamic and vermian lesions. 

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

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