Fig. 2

Multi-parametric MRI dynamic changes of the brain of a 3-year-old patient who died; on admission, he presented with respiratory disorders, fever, intractable convulsion, then DCL. He was diagnosed with ANEC. Axial images: a and b FLAIR, c T1 WI, d T2 WI, which reveal bilateral thalamic swelling with altered signal intensities being hyperintense in T2WI and FLAIR, and also bright signal in T1WI likely hemorrhage, a similar bilateral symmetrical areas of signal alteration are seen implicating the posterior limb of internal capsule, external capsule, putamia, periventricular cerebral WM, and posterior aspect of pons. e and f DWI and ADC show typical tricolor pattern of thalamic lesions showing peripheral restriction. g and h SWI shows foci of brain stem hemosiderin deposition; however, no signal loss on thalamic lesion. i Single-voxel spectroscopy with the region of interest being on the right thalamus and left lentiform nucleus with (TE, 115). Reduced NNA peak at 2 ppm, with a large lipid/lactate peak at 1.3 ppm (arrow)