A 10-year-old boy with developmental delay + mental abnormality, this case is said to be undiagnosed by 60% of doctors!

*Not easy to read for medical professionals.
The patient, male, 10 years old, presented with developmental delay and mental disorders
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Look at the image below, what do you consider the patient’s diagnosis? ---Answer dividing line---Are you sure you want to see the answer? ▌ Image analysis FLAIR images show that the medial cerebellar hemisphere, cerebellar nucleus, cerebellar peduncle, brain stem [medulla oblongata (a) and pons (b)] have abnormal symmetrical signals and no space-occupying effect
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▌ Imaging diagnosis of Leigh syndrome
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 ▌ Differential diagnosis 1.
Posterior encephalitis is an infection of the brain parenchyma.
The pathogen can be a virus or a bacteria because the infection spreads directly or spreads through blood
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Bacterial infections are common in immunosuppressed patients, and abscesses are likely to form if treatment is not timely
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Viral encephalitis mostly affects the deep gray matter and white matter of the brain.
Those that affect the hindbrain (cerebellum, pons, and medulla oblongata) are called posterior encephalitis
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Viral encephalitis is manifested as a high signal on the T2 image, involving the deep gray matter and white matter of the brain, including the cerebellum and brainstem
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2.
Demyelinating lesions Acute disseminated encephalomyelitis (ADEM) is the most common demyelinating lesion in children
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The course of the disease is uniphasic, mostly secondary to proviral infection or vaccination
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MRI showed continuous T2 hyperintensity lesions in the white matter, mostly bilateral, with asymmetrical distribution
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Involvement of the corpus callosum, cerebellar hemispheres, visual pathways, and brainstem are characteristic manifestations
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The lesion around the ventricle is oval and perpendicular to the lateral ventricle, forming a typical "Dawson finger" sign
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 ▌ Image points A.
Posterior encephalitis refers to the infection of the parenchyma of the back of the brain, including the cerebellum, medulla oblongata, and pons; B.
Demyelinating lesions mostly involve the cerebellum and brainstem, and ADEM is more common in children; C.
Metabolic disease is a rare neurodegeneration The clinical and imaging manifestations of sexual lesions are similar to those of degenerative lesions
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References: [1]Barkovich AJ, Good WV, Koch TK, et al.
Mitochondrial disorders: analysis of their clinical and imaging characteristics[J].
American Journal of Neuroradiology, 1993, 14(5): 1119-1137.
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