Cerebral HUS

There are extensive signal abnormalities throughout the thalami and the putamina with insula changes seen on this examination. Some of the heterogeneous nature of the signal is likely to be due to haemorrhagic change and the distribution of changes together with haemorrhagic nature is very suggestive of deep cerebral vein thrombosis and haemorrhagic venous infarction. Diffuse T2 signal abnormality is also seen in the rostral pons and medulla. Similar (but less extensive) changes have been reported in HUS. Metabolic or mitochondrial diseases could also give rise to similar distribution of change although the haemorrhagic components would be unusual. Acute necrotising encephalitis would be an alternative differential diagnosis to consider on imaging grounds.