Presentation
Encephalopathy
Patient Data
Edema/hyperintensity involving bilateral parietooccipital, temporal, frontoparietal lobes (cortex, subcortical white matter) and centrum semiovale. Multiple hemorrhagic foci are seen with areas of diffusion restriction. Edema/hyperintensity is also seen in the splenium of the corpus callosum and bilateral cerebellar hemispheres.
The hyperintensities on T1 may be attributed to a combination of hemorrhage and possibly early cortical laminar necrosis.
Case Discussion
Based on imaging findings alone, possible differential diagnoses were atypical posterior reversible encephalopathy syndrome and hemorrhagic shock and encephalopathy syndrome.
On further discussion with the pediatric neurology team, the child was found to have multiorgan dysfunction, hypovolemia, thrombocytopenia, metabolic acidosis, elevated liver enzymes and creatine kinase which suggested the diagnosis of hemorrhagic shock and encephalopathy syndrome.
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