Acute febrile encephalopathy and seizures in children with diffusion restriction lesions on magnetic resonance imaging brain

Over the last decade, several entities within the spectrum of acute febrile encephalopathy (AFE) including acute disseminated encephalomyelitis, acute necrotizing encephalitis, fever-induced refractory epilepsy syndrome, clinically mild encephalopathy with reversible splenial lesion, and autoimmune encephalitis have been recognized, all of which now have reasonably well-established clinicoradiological diagnostic criteria and therapeutic options. This case series highlights the clinical profile and outcome of seven children with the lesser-known entity of AFE with seizures and white matter diffusion restriction lesions on magnetic resonance imaging. All children had a history of acute onset fever, altered sensorium, and refractory seizures requiring multiple antiepileptic drugs and presented in shock requiring multiple organ support. All had extensive, diffusion-restricted lesions involving white matter. The infectious trigger was identified as influenza A (H3N2) in case 1, dengue virus in cases 2 and 6, and influenza B in case 4. Five children survived, each of whom had significant neurological sequelae.