To the Editor.

My colleagues and I have read with interest the report by Ruggieri et al regarding selective, reversible thalamic involvement with measles infection. Concerning the etiology of selective, reversible thalamic involvement, the authors concluded that deep cerebral vein thrombosis (DCVT) caused it. We could not deny their hypothesis. However, recently we observed two cases with similar magnetic resonance imaging (MRI) findings and clinical course attributable to influenza A infection. These cases were diagnosed as having the mild form of acute necrotizing encephalopathy (ANE). The authors never mentioned ANE as a possible etiology.

Our cases were previously healthy Japanese boys, aged 2 and 5. Both had acute encephalopathy without pleocytosis in cerebrospinal fluid. Their computed tomography (CT) and MRI showed selective, reversible thalamic involvement and no evidence of DCVT. They recovered without sequelae and disturbance of sensation. Influenza A infection was confirmed serologically in both cases....

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