Clinical and Neuroimaging Features of Basal Ganglia Encephalitis in Children.

Authors

Ling Zhou, Zemou Yu, Jingjing Jia, Hong Jin, Jiuwei Li, Hui Xiong, Xiuwei Zhuo

Published in

Pediatric neurology. Volume 182. Pages 119-124. Jun 29, 2026. Epub Jun 29, 2026.

Abstract

Postinfectious neurological syndromes in children encompass a spectrum of immune-mediated disorders. To delineate the clinical features, neuroimaging characteristics, and long-term outcomes of a distinct pediatric postinfectious syndrome involving acute, symmetric basal ganglia lesions, termed "basal ganglia encephalitis."
We performed a retrospective study on a cohort of pediatric patients admitted to Beijing Children's Hospital. Eligibility criteria required normal baseline development, acute neurological onset within 6 weeks of infection, and symmetric basal ganglia lesions on cranial magnetic resonance imaging (MRI). Metabolic, demyelinating, toxic, or other etiologies were excluded. Clinical, laboratory, and longitudinal follow-up data were systematically reviewed.
Twenty-one patients (14 males) with a median onset age of 7.5 years were identified. The initial symptoms comprised altered consciousness or behavioral changes (10/21, 47.6%), followed by movement disorders (8/21, 38%) and seizures (6/21, 28.5%). Evidence of Mycoplasma pneumoniae infection was confirmed in 14 patients (66.7%). Cerebrospinal fluid analysis revealed mild pleocytosis in 66.7% and positive oligoclonal bands in 42.1%. Acute brain MRI consistently demonstrated symmetric basal ganglia T2/Fluid-Attenuated Inversion Recovery hyperintensities with characteristic apparent diffusion coefficient hyperintensity, indicative of vasogenic edema. All children received immunotherapy, and 15 patients also received antimycoplasma treatment. Eighteen children (85.7%) had achieved complete neurological recovery at a median follow-up of 3.5 years; only three patients exhibited minor residual neurological deficits. Follow-up MRI (n = 17) showed significant lesion resolution.
Basal ganglia encephalitis is a distinct immune-mediated pediatric syndrome frequently associated with M. pneumoniae, radiologically characterized by symmetric basal ganglia lesions. The majority of patients achieve favorable outcomes with anti-infective and immunotherapy.

PMID:
42475768
Bibliographic data and abstract were imported from PubMed on 21 Jul 2026.

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