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NEUROIMAGES
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 610-611

Acute necrotizing encephalopathy of childhood


Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra, Tanda, Himachal Pradesh, India

Date of Web Publication13-May-2019

Correspondence Address:
Dr. Madhurima Sharma
Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra, Tanda - 176 001, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.257990

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How to cite this article:
Sharma M, Sood D, Chauhan NS, Negi P. Acute necrotizing encephalopathy of childhood. Neurol India 2019;67:610-1

How to cite this URL:
Sharma M, Sood D, Chauhan NS, Negi P. Acute necrotizing encephalopathy of childhood. Neurol India [serial online] 2019 [cited 2019 May 24];67:610-1. Available from: http://www.neurologyindia.com/text.asp?2019/67/2/610/257990




A 3-year old, previously healthy female child presented to the emergency department of our institute with history of seizures and altered sensorium for the past 1 day. The child had undocumented fever for the past 4 days. On examination, meningeal signs were absent. Noncontrast computed tomography of the head showed hypodense lesions in bilateral thalami, putamen, external capsule, and brain stem tegmentum [Figure 1]. The cerebrospinal fluid (CSF) analysis was normal. Magnetic resonance imaging of the brain was done after an interval of 10 days; it showed bilateral symmetrical lesions in thalami (white arrow) and tegmentum (black arrow) which were hyperintense to grey matter on T2 and FLAIR images [Figure 2]a and [Figure 2]b. The thalamic lesions were iso- to hyperintense on T1-weighted images, while tegmental lesions were isointense to grey matter [Figure 2]c. Bilateral thalamic lesions showed peripheral postcontrast enhancement [Figure 2]d. In addition, peripherally enhancing lesions were also noted in bilateral putamina (curved arrow). Diffusion-weighted imaging showed diffusion restriction in all lesions. Based on the above findings, a diagnosis of acute necrotizing encephalopathy of childhood was made.
Figure 1: Axial noncontrast computed tomography section of the brain showing hypodense lesions in bilateral thalami (white arrows in a), putamina and external capsule (curved arrows in a), and brainstem tegmentum (black arrows in b)

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Figure 2: Axial T2-weighted (a) and FLAIR (b) magnetic resonance imaging images showing symmetrical lesions in bilateral thalami (white arrows) and brainstem tegmentum (black arrows). Bilateral thalamic lesions showed patchy hyperintensity on T1-weighted images (c) with postgadolinium enhancement (d). While tegmental lesions were isointense to grey matter on T1-weighted images (c) with no significant postcontrast enhancement (d). Also note the presence of peripherally enhancing lesions in bilateral putamina (curved arrows in d)

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Acute necrotizing encephalopathy of childhood affects infants and young children with a high mortality. Although the exact etiopathogenesis is not clear, viral, immunological, and metabolic factors have been implicated as possible etiological factors. Neuroimaging is characterized by symmetrical lesions in bilateral thalami, putamina, brainstem, cerebral, and cerebellar white matter, and the lesions frequently show hemorrhage and diffusion restriction.[1],[2],[3] Acute disseminated encephalomyelitis and viral encephalitis remain the main differential diagnosis. However, a normal CSF study and the characteristic location of lesions help in making a diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wong AM, Simon EM, Zimmerman RA, Wang HS, Toh CH, Ng SH. Acute necrotizing encephalopathy of childhood: Correlation of MR findings and clinical outcome. Am J Neuroradiol 2006;27:1919-23.  Back to cited text no. 1
    
2.
Biswas A, Varman M, Gunturi A, Yoganathan S, Gibikote S. Teaching neuroimages: Acute necrotizing encephalopathy of childhood: Neuroimaging findings. Neurology 2018;90:e177-8.  Back to cited text no. 2
    
3.
Ormitti F, Ventura E, Summa A, Picetti E, Crisi G. Acute necrotizing encephalopathy in a child during the 2009 influenza A (H1N1) pandemia: MR imaging in diagnosis and follow-up. Am J Neuroradiol 2010;31:396-400.  Back to cited text no. 3
    


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