Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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MRI Findings of COVID-19 Associated Acute Necrotizing Encephalopathy in Two Pediatric Patients: Case Report and Literature Review

소아에서 발생한 COVID-19 연관 급성 괴사성 뇌병증의 MRI 소견: 2건의 증례 보고 및 문헌 고찰

  • Yoon Yeong Choi (Department of Radiology, University of Inha College of Medicine) ;
  • Ha Young Lee (Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Myung Kwan Lim (Department of Radiology, University of Inha College of Medicine) ;
  • Young Hye Kang (Department of Radiology, University of Inha College of Medicine)
  • 최윤영 (인하대학교 의과대학 영상의학교실) ;
  • 이하영 (가톨릭대학교 의과대학 은평성모병원 영상의학과) ;
  • 임명관 (인하대학교 의과대학 영상의학교실) ;
  • 강영혜 (인하대학교 의과대학 영상의학교실)
  • Received : 2023.03.09
  • Accepted : 2023.08.21
  • Published : 2024.05.01
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Abstract

Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral 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)-associated 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 symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral 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 literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.

급성 괴사성 뇌병증은 바이러스 감염의 드문 면역 매개 합병증이다. 일반적으로 양쪽 시상을 침범하며, 주로 어린이에서 보고된다. 저자들은 소아에서 발생한 코로나바이러스감염증과 관련된 급성 괴사성 뇌병증 2건을 보고하고자 한다. 7세 여아는 발열과 의식변화, 6세 여아는 발열과 전신성 간질로 내원하였다. 뇌 MRI에서 두 환자 모두 양쪽 시상에 중심부 출혈을 동반한 대칭적인 액체감쇠역전회 고신호강도 병변이 보였고, 한 환자에서는 겉보기확산계수에서 시상에 층상 병변이 보였다. 저자들은 이 보고를 통해 급성 괴사성 뇌병증의 특징적인 뇌 MRI 영상 소견을 인지함으로써 심각한 신경학적 증상을 나타내는 코로나바이러스감염증 환자의 경우 특히 소아에서 영상 소견을 바탕으로 한 빠른 진단이 필요함을 강조하고자 한다. 또한, 급성 괴사성 뇌병증을 시사하는 양측 시상의 출혈성 괴사로 나타났던 코로나바이러스 감염 증례에 대한 문헌을 검토하고자 한다.

Keywords

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