case_images: PMC10838156_01
case_images: Imaging studies. (A) day 2 CT scan, (B) day 16 T1-weighted image, (C) day 16 T2-weighted image, (D) day 16 fluid-attenuated inversion recovery, (E) day 16 diffusion-weighted image, (F) day 16 apparent diffusion coefficient map
case_images: cureus-0016-00000051665-i01.jpg
case_images: PMC10838156_01_cureus-0016-00000051665-i01.jpg
case_images: FIG1
case_images: No brainstem lesion was present (Figure 1). Head MRI on day 16 demonstrated symmetric high intensity in a T2-weighted image of the bilateral thalamus (mainly in the ventral posterior complex), compatible with ANE, as well as occipital and parietal cortical and subcortical regions (Figure 1).
case_images: The clinical course of the patient. The days of illness were defined by the day when altered consciousness was observed (onset of encephalopathy. TPE, IVMP, and IVIg are indicated by red, orange, and green arrows, respectively.. Abbreviations: ANE-SS, acute necrotizing encephalopathy severity score; CHDF, continuous hemodiafiltration; CHD, continuous hemodialysis; IVMP, intravenous methylprednisolone; IVIg, intravenous Immunoglobulin; PPV, predicted plasma volume; TPE, therapeutic plasma exchange
case_images: cureus-0016-00000051665-i02.jpg
case_images: PMC10838156_01_cureus-0016-00000051665-i02.jpg
case_images: FIG2
case_images: In addition to neurocritical care, a course of three-day intravenous methylprednisolone (IVMP, 30 mg/kg/day) and a course of five-day TPE to remove proinflammatory cytokines were introduced 24 hours after onset (Figure 2).