The images show symmetrical bilateral putaminal vasogenic oedema with mild restriction on diffusion and no bleed.
The possibilities are
1.Methanol intoxication- should show bleed and opitc nerves involvement
2. Wilson disease- usually shows calcium to some extent apart from other basal ganglia ivolvement
3.Hypoxic ischaemic insults – should involve caudate and other graymatter nuclei
4. Leighs syndrome
6. Striatal degeneration ass with lebers optic atrophy
7.Certain types of metabolic disorders
8.Carbonmonoxide poisoning-specially involves globus pallidus as well
9. Near drowning hypoxic anoxic injury
In our 4 yr old girl child, as the CSF is negative and she has staus epilepticus and other regions are not involved, slow viral disease causing encephalitis is possible. However classical SSPE should show starting from occipital cortex, then partietal and then other regions including basal ganglia, brainstem and post fossa white matter necrosis Imaging can be normal as well in SSPE. rpes encephalitis involves Temporal regions. Dengue, and Japanese B encephalitis usually involve thalami.
Case by Dr MGK Murthy, Sr Consultant Radiologist