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Infection-triggered encephalopathy syndrome in children: a neuroimaging perspective.

Jiah Shin1, Young Hun Choi2,3, Woo Joong Kim4

  • 1Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Pediatric Radiology
|February 12, 2026
PubMed
Summary

Infection-triggered encephalopathy syndromes are acute brain conditions linked to fevers, diagnosed using specific MRI findings. Recognizing these neuroimaging patterns is crucial for accurate diagnosis and prognosis in children.

Keywords:
EncephalopathyInfection-triggered encephalopathy syndromeMagnetic resonance imagingNeuroimagingPediatrics

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Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Infectious Diseases

Background:

  • Infection-triggered encephalopathy syndromes (ITES) are acute encephalopathies associated with febrile illnesses.
  • Unlike infectious or autoimmune encephalitis, ITES typically lack direct viral invasion or antibody-mediated pathology.
  • Excitotoxicity and cytokine storm are implicated as key pathogenic mechanisms.

Purpose of the Study:

  • To review the epidemiology, clinical characteristics, and neuroimaging features of infection-triggered encephalopathy syndromes.
  • To emphasize the critical role of magnetic resonance imaging (MRI) findings in the diagnostic criteria for ITES.
  • To highlight characteristic radiological patterns essential for diagnostic classification and prognostication.

Main Methods:

  • Review of epidemiological data and clinical presentations of ITES.
  • Analysis of neuroimaging features, particularly MRI findings.
  • Emphasis on characteristic radiological patterns like 'bright tree appearance', bithalamic involvement, and reversible splenial lesions.

Main Results:

  • MRI findings are indispensable for confirming ITES and differentiating them from other encephalopathies.
  • Specific radiological patterns aid in diagnostic classification and prognostication.
  • Familiarity with these patterns is essential for pediatric radiologists for early recognition.

Conclusions:

  • Neuroimaging, especially MRI, is critical for diagnosing infection-triggered encephalopathy syndromes.
  • Characteristic MRI findings are key to classifying ITES and predicting outcomes.
  • Early recognition of these neuroimaging patterns by pediatric radiologists is vital for appropriate patient management.