# Acute Necrotizing Encephalopathy of Childhood: A Report of Two Cases

## TL;DR

This paper reports two cases of a rare and severe brain disorder in children, highlighting the importance of early MRI diagnosis and aggressive treatment.

## Contribution

The paper contributes two detailed case reports of ANEC in children, emphasizing diagnostic and management challenges.

## Key findings

- ANEC presents with nonspecific symptoms like fever and seizures, requiring MRI for accurate diagnosis.
- MRI reveals characteristic bilateral or diffuse brain lesions, which can vary in distribution and severity.
- Aggressive supportive care and immunomodulation are critical for managing ANEC in children.

## Abstract

Acute necrotizing encephalopathy of childhood (ANEC) is a rare, severe disorder in previously healthy infants and children, associated with high morbidity and mortality. Early recognition is essential for timely management. We report two pediatric cases. A three-month-old female infant presented with hypotonia, feeding refusal, and lethargy; MRI revealed bilateral, symmetrical thalamic lesions with edema. A four-year-old female developed status epilepticus following a febrile illness; imaging showed diffuse, asymmetrical cortical and subcortical lesions, including hemorrhagic changes in the thalami and brainstem. Both patients received aggressive supportive care, immunomodulation with corticosteroids, and empiric antimicrobial therapy. The second patient also required intensive management for status epilepticus. ANEC presents with nonspecific symptoms such as fever, seizures, and altered consciousness. MRI is crucial for diagnosis, demonstrating characteristic lesions that may vary in distribution and severity. Early neuroimaging, prompt supportive care, and awareness of lesion variability are essential for accurate diagnosis and optimizing outcomes in children with ANEC.