Fig. 4

Multi-parametric MRI dynamic changes of the brain of a 5-year-old patient who was left with moderate sequelae. He presented with fever, tonic colonic convulsions, then DCL. He was diagnosed with ANEC. At the onset of the disease, axial images (a) T1 WI (b and c) T2 WI reveal lesions on bilateral swollen thalami, basal ganglia, and dorsal external capsule tegmen of pons, WM cerebral parenchyma and WM of both cerebellar parenchyma being low signal in T1WI, heterogeneous high signal in T2WI. d and e DWI and ADC show peripheral restriction on DWI and typical tricolor pattern of thalamic lesions on ADC. f Single-voxel MRS (TE, 115) of basal ganglia shows reduced NNA peak and increased lipid/lactate complex peak intensities at 0.8–1.5 ppm. Follow-up after 3 weeks, axial images (g and h) T1 WI reveal disappearance of WM cerebellar lesion, impressive regression of the thalamic size being of high signal (subacute hemorrhage), also regression of brain stem lesion, basal ganglia, and external capsule with subtle bright signal, moderate increased CSF spaces, and ventricular size (i and j) contrast-enhanced MRI show no appreciable enhancement. k and l DWI shows restriction of pons lesions. m and n SWI shows signal drop in thalamic and brain stem lesions (hemosiderin). o Single-voxel MRS shows reduced the lactate peak and the NAA peak returns within the normal range