Viral encephalitis in the pediatric population is an acute and rare inflammation of the brain parenchyma caused by a viral infection, leading to significant neurological dysfunction. MRI plays a crucial role in establishing differential diagnoses withch can be challenging due to the variability of imaging findings described in the literature and the influence of geographic factors. A specific pathogen can cause different MRI appearances, while a particular imaging pattern may be associated with multiple infections.

We reviewed the clinical and imaging data of five pediatric patients presenting with neurological symptoms.

Three patients presented with HSV-related encephalitis, aged between 7 months and 1 year.

• A 9-month-old child presented with fever, critical febrile focal seizures, and left hemicorporal convulsive status [Fig. 1]. The same patient, 6 months later, presents with: left hemicorp focal motor status and myoclonus [Fig. 2]. 
• A 1-year-old child experienced a critical episode characterized by fixed gaze, jaw clenching, and non-responsiveness for a few minutes [Fig. 3].
• A 7-month-old child presented with cough, fever, vomiting, and diarrhea that had begun approximately three days prior, followed by convulsions affecting the right hemicorp [Fig. 4].

Two patients had a history of measles infection, both unvaccinated.

• A 3-year-old unvaccinated child presented with fever, tonic-clonic seizures, fixed gaze, and deviation of the eyeballs to the left [Fig. 5].
• A 5-year-old unvaccinated child, with a history of measles infection 3–4 years ago, presented with generalized tonic-clonic seizures, vomiting, and fixed gaze. The final diagnosis in this case was subacute sclerosing panencephalitis [Fig. 6].

All patients underwent MRI examination, cerebrospinal fluid (CSF) analysis, and immunological testing.