Presentation
Fever and altered sensorium
Patient Data
There are asymmetrical areas of signal alteration in the left limbic system, medial temporal lobe, insular cortex, and bilateral high frontal lobes in the parasagittal region involving the cortex and white matter with sparing of basal ganglia. This region appears hyperintense on T2W/FLAIR images, with mild diffusion restriction on DWI, and no significant enhancement on post-contrast images.
A Few small areas of hypointensity on SWI with the corresponding hyperintensity on phase images in the bilateral high frontal lobe in the parasagittal region, suggestive of hemorrhage.
Case Discussion
Rapid PCR in the CSF sample detected herpes simplex virus type-1.
CSF study shows lymphocytosis with increased protein.
So imaging and CSF study are suggestive of herpes simplex hemorrhagic encephalitis.
Co-author: Dr. Sanaullah Mudassir, DM (Neuro medicine).