Clinical Profile of Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion

Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a rare infection-associated condition identified by clinical and radiological features. It typically presents with febrile seizures followed by a second seizure cluster with encephalopathy after 4–6 days, often showing a bright tree appearance on magnetic resonance imaging. We report three cases, all female patients aged 2, 2.5, and 3 years, demonstrating biphasic illness patterns and bilateral diffusion restriction sparing the peri-rolandic regions. Two of them experienced super-refractory status epilepticus; one developed right-sided hemiparesis. They required mechanical ventilation and treatment with pulse-dose methylprednisolone and antiepileptics. Staphylococcus aureus was identified in one case, with likely viral causes in the others. This series highlights AESD’s severity, management, and prognosis, stressing the need for clinician and radiologist awareness for accurate diagnosis and effective treatment.