RESUMO

To show the MRI findings in a rare case of acute necrotizing encephalopathy following SARS-CoV-2 infection in an adult patient. Acute necrotizing encephalopathy is a rare condition characterized by the presence of symmetrical multifocal lesions with predominantly thalamic involvement, as well as the brainstem and cerebellum. We describe the case of a 26-year-old male with a medical history of medulloblastoma that was disease-free after treatment and who tested positive in a PCR for SARS-CoV-2 in cerebrospinal fluid. Upon evaluation at the emergency department one week later, the patient was found to be awake, oriented, and focused and could maintain attention for periods of time. Mixed dysarthria persisted, characterized by being flaccid and hypokinetic. On magnetic resonance imaging, there were multiple hemorrhagic lesions with surrounding edema in the right thalamus with an extension to the posterior arm of the internal capsule, a smaller one in the left thalamus, and another expanded to the ipsilateral peduncle. Acute necrotizing encephalopathy presents a great clinical and diagnostic challenge, close clinical and radiological follow-up is essential, and magnetic susceptibility sequences (T2 or SWI) should be included in the diagnosis protocol.