6 months female, developmentally normal, previously immunised presented with 10 days history of recurrent multifocal seizures, undocumented low grade fever, left sided upper limb monoparesis.... Lumbar puncture 40 cells pred. mononuclear, sugar and protein normal. Initially treated as meningitis, developed choreoathetoid movements of both upper extremities. Currently seizures controlled, sensorium normal, weakness improved. MRI shown.... what are possible differentials...

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Looks like mutlifocal luekoencephalopathy , with chronic areas in right basal ganglia , Subacute acute in the left bg and right medial temporal lobe , ventricles are prominent , right more than the left probably due to porencephaly . Choreathetoid movements should be due to basal ganglia involvement primarily. CSF looks like viral cause ..may want to check for herpesviridae family viruses. Diffusion , susceptibility and mra images would help further . Collagen vascular disorders also could be a distant possibility like col4a1 mutations, and Melas
Clinical picture is that of meningo-encephalitis. Csf picture seems to be that of aseptic meningitis. Viral etilogy, ricketsiall and malaria will be differentials. Imaging features are that of involvement of multiple areas, including gray and white matter more on the right side. Since the child is improving, infective etiology will be on top. However i would request to please consider repeat imaging if possible and with contrast. Thanks.
As the disease looks acute based on historical data and child has clinically improved, diagnosis of acute encephalitis seems appropriate. But MRI shows cystic encephalomalacia with gliosis in right ganglicapsular region, shud we consider chronuc causes of basal ganglia abnormalitis Can it be recurrent infarct due to vasculopathy like Moya moya disease Shud we consider mitochondrial ( leigh disease, MELAS), Organic acedemia (MMA, GA) Shud we work for these possibilities or we shud follow up the case...... Kindly give your opinions; thank you@Dr. Nihaal Reddy @Curofy

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Something in the left basifrontal region too .. is it a granuloma or abscess ? Like Dr shaikh mentioned need contrast images too
Rule out Autoimmune encephalitis NMDA receptor

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