[Brainstem hemorrhage following acute necrotizing encephalopathy]

Area of Science:

• Neurology
• Pediatric Neurology
• Neurocritical Care

Background:

• Acute necrotizing encephalopathy (ANE) is a rare neurological disorder typically affecting children.
• It is characterized by acute onset of neurological dysfunction following a febrile illness.
• Brainstem hemorrhage is an uncommon but severe complication of ANE.

Observation:

• A 5-year-11-month-old boy with a history of febrile seizures presented with high fever and coma.
• Initial brain CT was normal, but subsequent imaging revealed bilateral thalamic, putaminal, midbrain, pontine, and cerebellar lesions.
• Electroencephalography (EEG) showed a suppression-burst pattern, progressing to a flat line.

Findings:

• The patient developed massive brainstem hemorrhage on the fourth day of hospitalization.
• Despite intensive care, the patient experienced multiple organ failure and died on the eighth day.
• This case represents the first documented instance of massive brainstem hemorrhage associated with ANE.

Implications:

• This case highlights the potential for severe hemorrhagic complications in ANE.
• Understanding the progression of ANE is crucial for timely diagnosis and management.
• Further research is needed to elucidate the pathophysiology and improve outcomes for ANE patients.