A 20-year-old man was admitted to the hospital due to hypotonia, dystonic movements, and dysarthria. The patient’s symptoms began and had been progressing since the age of 5, when he experienced an episode of enteroviral encephalitis. The patient’s family history included no relevant information. His blood count, biochemistry, and cerebrospinal fluid at the time of admission were unremarkable. Laboratory investigation yielded negative findings for Huntington’s disease, neuroacanthocytosis, Wilson’s disease, and mitochondrial encephalopathies. Brain magnetic resonance imaging showed bilateral volume loss, and high signal intensity of the caudate nuclei and putamina on a fluid attenuation inversion recovery sequence, with no enhancement after contrast injection (Figure 1). Given his clinical history of viral encephalitis associated with progressive neurological symptoms and imaging findings, enterovirus-associated bilateral striatal necrosis (BSN) was the most likely diagnosis.
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