Presentation
Fever followed by disturbed level of consciousness and seizures.
Patient Data
There are bilateral symmetrical signal abnormalities involving both thalami, brainstem tegmentum and cerebellar white matter. They appear hyperintense on T2, FLAIR, and DWI while hypointense on T1. Other smaller foci of diffusion restriction are also seen involving the cerebral white matter. The thalamic abnormalities show blooming on SWI. No post-contrast enhancement is seen.
Spectroscopy shows abnormally elevated lipid/lactate and glutamine/glutamate peaks.
There is a remarkable regression in the size and intensity of the previously seen signal abnormalities with evolution on T1 consistent with aging blood products.
Case Discussion
The described findings are highly suggestive of acute necrotizing encephalopathy of childhood. Follow-up MRI revealed disease regression following medical treatment.
Case courtesy: Prof. Dr. Yasser Ragab
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