The case of a 4-year-old girl with bilateral edema of the basal ganglia in association with echo type 21 viral infection is reported from the University Hospitals of Munster and Hamburg, Germany. Following an acute upper respiratory infection, the child developed viral meningitis, complicated by muscle hypotonia, ataxia, resting tremor, drowsiness, hyperesthesia, and speech dysarthria. MRI T2-weighted images showed hyperintense lesions of caudate nucleus, putamen, pallidum, and cerebellar peduncles, consistent with edema. Recovery began after 9 weeks, with a normal MRI and CSF at 3 months follow-up. 
COMMENT. The authors cite 15 similar reports of pediatric postinfectious acute encephalopathies with striatal lesions, mostly with unspecified respiratory infection and more severe course, 4 diagnosed at autopsy. Other acute causes of bilateral striatal lesions include trauma, hemolytic-uremic syndrome, carbon monoxide, methylmalonic acidemia, glutaric aciduria type 1, sulfite oxidase deficiency, MELAS, hypoxia-ischemia, and vasculitis.