PMC4421882_01
23-year-old female presented with headache and fever was diagnosed with acute necrotizing encephalopathy. Axial FLAIR MR images (a) at the level of pons and cerebellum show hyperintense signals (arrowheads) in the pons and cerebellum and (b) at the level of thalami shows hyperintense signals in bilateral thalami (arrowheads).
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F1
Magnetic resonance imaging (MRI) done revealed areas of altered signal intensity (predominantly hyperintense) involving thalami, pons, midbrain, and cerebellum on fluid-attenuated inversion recovery (FLAIR) [Figure 1a and b].
23-year-old female presented with headache and fever was diagnosed with acute necrotizing encephalopathy. Axial (a) T2-weighted (T2W) and (b) T1-weighted images at the level of thalami show hyperintense signal in bilateral thalami and the posterior limb of internal capsule on T2W (white arrowheads) and hypointense signal on T1-weighted images (arrowhead). T2W image shows increased signal (red arrowhead) in the center representing necrosis.
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F2
The involved areas were predominantly hyperintense on T2W images with focal higher signal areas representing necrosis [Figure 2a and b].
23-year-old female presented with headache and fever was diagnosed with acute necrotizing encephalopathy. Axial gradient images (a) at the level of pons and (b) thalami show blooming representing hemorrhages (white arrowheads) in bilateral thalami and the pons.
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F3
On gradient sequence, blooming was noted in bilateral thalami representing hemorrhages [Figure 3a and b].
23-year-old female presented with headache and fever was diagnosed with acute necrotizing encephalopathy. (a) Axial diffusion and (b) apparent diffusion coefficient images show restrictions (arrowheads) representing necrosis and hemorrhages. Note the areas of hemorrhage are small compared to necrosis on diffusion images, suggesting coexisting hemorrhage and necrosis.
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F4
On diffusion-weighted MR imaging, focal areas of restriction were noted in bilateral thalami representing cytotoxic edema [apparent diffusion coefficient (ADC) 40 x 10-3 mm/s], surrounding necrosis [ADC 120 x 10-3 mm/s], and hemorrhage [Figure 4a and b].