Acute necrotizing encephalopathy of childhood (ANEC) is a fulminant type of encephalopathy. Most reported cases occur in Asian children with the highest prevalence among patients between the age of 6 and 18 months. The most common clinical presentations are fever, rapid alteration in the level of consciousness, and seizures, in addition to characteristic findings in brain imaging that include, but are not limited to, bilateral thalamic lesions with supra and infra-tentorial lesions of variable dimensions.

The diagnosis of ANEC was determined by specific diagnostic criteria as described by Mizuguchi [1] which consist of

1. Encephalopathy preceded by viral febrile illness with rapid deterioration in the level of consciousness and convulsions.
2. Absent cerebrospinal fluid (CSF) pleocytosis.
3. Symmetric multifocal brain lesions.
4. Elevation in serum aminotransferase levels.
5. Exclusion of similar diseases. The ANE severity score was used to assess the severity of illness after admission for shock (3 points), brainstem lesions (2 points), age >4 years (2 points), platelet (PLT) count < 100,000 (1 point), and elevated CSF protein (1 point) was observed. [3] A total score of 9

Inclusion Criteria:

- Children aged from 2months up to 12 years admitted to the pediatric emergency department or pediatric ICU presented with Acute encephalopathy & meet diagnostic criteria of acute necrotizing encephalopathy or come for follow up in our outpatient clinic.

Exclusion Criteria:

• Children known to have metabolic disease. Children who have picture of CNS infection & confirmed by CSF analysis.

Children aged from 2months up to 12 years admitted to the pediatric emergency department or pediatric ICU presented with Acute encephalopathy & meet diagnostic criteria of acute necrotizing encephalopathy or come for follow up in our outpatient clinic.