Clinical and Radiologic Findings of Acute Necrotizing Encephalopathy in Young Adults

Fellows’ Journal Club

The authors describe 10 patients (16 years of age or older) with acute necrotizing encephalopathy. In their study, bilateral thalamic involvement with the trilaminar pattern of diffusion restriction on MR imaging was the predominant finding seen in all of the patients reviewed. Ancillary findings of cerebral white matter, brain stem, and cerebellum involvement with sparing of the basal ganglia were also seen.

Abstract

Figure from Vanjare et al
A–E, T2-weighted axial sections demonstrating the involvement of cortical gray matter, white matter, thalami, brain stem, and cerebellar hemispheres. F–I, DWI axial sections demonstrating diffusion restriction in thalami, cerebral, and cerebellar white matter. Trilaminar pattern on ADC (G) as a low signal ring (arrows) with central and peripheral hyperintensity. J and K, SWI demonstrating microhemorrhages in thalami and brain stem.

Acute necrotizing encephalopathy after an acute febrile illness, although initially described exclusively in the pediatric age group, has been recently shown to have an adult onset as well. In this study, we describe 10 patients (16 years of age or older) with acute necrotizing encephalopathy. In our study, bilateral thalamic involvement with the trilaminar pattern of diffusion restriction on MR imaging was the predominant finding seen in all of the patients reviewed. Ancillary findings of cerebral white matter, brain stem, and cerebellum involvement with sparing of the basal ganglia were also noted. A poorer outcome was observed in patients with a higher degree of thalamic involvement. The cause of an underlying infection was identified in 4 patients (dengue in 3 and influenza in 1). Overall, a sizeable portion of young adults with acute necrotizing encephalopathy have shown a poorer outcome, with dengue being an important underlying trigger in an endemic region.

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Clinical and Radiologic Findings of Acute Necrotizing Encephalopathy in Young Adults
Jeffrey Ross
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