Abstract
In the United Kingdom, 2010 saw the second anticipated rise in the number of cases of novel influenza A H1N1 pdm09 (swine flu). Fatal outcomes largely relate to pulmonary sequel with fatal frank intracranial complications occurring much less frequently. Acute necrotizing encephalopathy is one such complication with a variable, but sometimes fatal, out- come. The condition has been reported largely in the East Asian pediatric population and is a very infrequent and elusive diagnosis largely because of the lack of recognition of the radiological appearances. The present case was diagnosed as a result of correlation of peri-mortem magnetic resonance imaging appearances of the brain with neuropathological findings at formal autopsy and brain necropsy: the virus was detected through reverse transcriptase polymerase chain reaction analysis and necropsy demonstrated classical features of necrosis in affected brain parenchyma with notable absence of inflammatory infil- trate. The report seeks to highlight the salient radiological feature of symmetrical hemorrhagic bilateral thalamic lesions - the presence of this particular feature in the appropriate clinical setting should prompt consideration of this radiologically elusive diagnosis.
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