Introduction: With widespread use of modalities like MRI, many novel causes of febrile encephalopathy like acute necrotising encephalitis, ADEM are bieng described. Acute leucoencephalopathy with restricted diffusion (ALERD) is emering as an important cause of acute encephalopathy in children. There is scant literature on this from India. Methods: Retrospective chart review of patients with a diagnosis of ALERD was done from Jan-2015 till June-2018. The data was extracted and analysed. Results: Fifteen patients had a diagnosis of ALERD with mean age of the patients 4.6 years (Range:1-13 yrs). Eight of them were males. All of them presented with fever, seizures and altered sensorium. Biphasic clinical picture with improvement on 2-4th day and subsequent worsening was not seen in any of them. The mean duration of hospital stay was 28.1 days. MRI of all children showed areas of diffusion restriction in the white matter and 12 of them also had restricted diffusion in the gray matter also. There were no deaths and modified Rankin score after 12 mon of follow up was 2.1. Ten out of 12 children had post-encephalitic epilepsy and these kids had cognitive sequalae with hyperactivity. The three without post-encephalitis epilepsy had mRS score of 0 and 1 and were scholastically normal. MRI after 6-12 months showed resolution of lesions with cerebral atrophy.

Conclusions: ALERD is emerging as an important cause of acute febrile encephalopathy in children. Most of them have a prolonged clinical course and have long term sequelae like post encephalitis epilepsy and cognitive delay.