Diagnosis of an Abnormality in Brain MRI

A 5 year old boy was admitted due to insidious onset of fever, lethargy, malaise and oral lesions from 20 days ago and then lost consciousness and had two generalized tonic-clonic seizures after hospitalization in ICU. The cerebrospinal fluid (CSF) and blood evaluation was not remarkable except for triglyceride 243 mg/dl, cholesterol 264 mg/dl and lactate de-hydoganse 641 mg/dl, blood and CSF lactate was normal. Brain MRI showed diffuse bilateral basal ganglia involvement (Fig. 1). After discharge the patient had sequels of the disease as spasticity, loss of speech, generalized dystonia, and difficulty in sucking and swallowing.