[Brainstem hemorrhage following acute necrotizing encephalopathy].

We report here a case of acute necrotizing encephalopathy (ANE) showing brainstem hemorrhage. A 5-year-11-month-old boy with a history of febrile seizures was admitted to our hospital because of high fever and coma. Laboratory studies on admission demonstrated elevated serum transaminase and blood glucose. Brain CT was normal on admission, but 9 hours later, it showed low density areas in the bilateral thalamus, putamen, midbrain, pons and cerebellum. Brain MRI revealed abnormal short T1 and long T2 signals in the same areas. Despite promptly performed intensive care, massive brainstem hemorrhage occurred on the fourth day. EEG showed a suppression-burst pattern followed by a flat pattern on the sixth day. The patient died on the eighth day of multiple organ failure. This is the first case of massive brainstem hemorrhage that occurred in association with ANE.