Case ReportHippocampal signal abnormality on the first day of illness in acute encephalopathy with biphasic seizures and late reduced diffusion caused by HHV-6 infection

We report a 13-month-old girl who developed acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) with transient reduced diffusion in the hippocampus and anterior commissure on diffusion-weighted imaging (DWI), which was performed on the first day after febrile status epilepticus (FSE) as the initial neurological symptom of AESD. DWI just after late seizures showed high signal intensity lesions in both left hippocampus and anterior commissure, and left extratemporal and occipital subcortical white matter. HHV-6 DNA was positive in both blood and cerebrospinal fluid samples. DWI at two months after onset showed atrophy in the left mesial temporal lobe and extratemporal and occipital lobe without the signal abnormalities.Although it has been reported that magnetic resonance images tend to show no acute abnormality during the first two days in typical AESD, transient reduced diffusion could be found on the DWI performed on the first day of AESD.