MRI Findings of COVID-19 Associated Acute Necrotizing Encephalopathy in Two Pediatric Patients: Case Report and Literature Review

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a vi-ral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-as-sociated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed sym-metrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilater-al thalamus with central hemorrhage. In one patient, the thalamic lesions showed a tri-laminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a lit-erature review of several documented cases of COVID-19 presenting with bilateral tha-lamic hemorrhagic necrosis, suggesting a diagnosis of ANE.