Central nervous system involvement in a child with hemolytic uremic syndrome

We report a 20-month-old girl with post-diarrheal (Shiga toxin) hemolytic u remic syndrome and severe encephalopathy. Magnetic resonance (MR) images we re obtained in the acute phase of the disease and after 10 months. The firs t MR images showed widespread high signal intensity on T2-weighted and low signal in tensity on T1-weighted images, in deep and subcortical white matt er; the splenium of the corpus callosum was also involved, as well as cereb ellar hemispheres. Neurological symptoms and signs gradually disappeared wi thin 35 days. Follow-up MR imaging showed almost complete resolution of the previous findings, and the patient recovered without central nervous syste m impairment. The neurological lesions were probably due to hypoxia, althou gh several other mechanisms could be involved, such as metabolic derangemen ts and the action of Shiga toxin. In spite of the dramatic clinical manifes tations, we observed a good outcome, indicating that patients with similar lesions do not necessarily have a poor prognosis.