Presentation
20 month old male patient with history of fever and seizure.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Single non-contrast CT image demonstrates low density in the right temporal lobe and bilateral inferior occipital / posterior temporal lobes.
Single axial FLAIR image demonstrating high T2 signal in the temporal and occipital lobe white matter.
CSF analysis showed:
- CSF WBC 82 (0-20%)
- CSF LYMPHS 80 (40-80%)
The rest of parameters were within normal.
HSV-PCR was positive.
Single non-contrast CT image 2 months later demonstrates low density and volume loss consistent with encephalomalacia.
Single axial FLAIR image 2 months later demonstrating striking bilateral encephalomalacia.
Case Discussion
Although HSV encephalitis in adults typically involves the medial temporal lobes, extensive involvement elsewhere (extra-limbic) is more common in children as is subsequent encephalomalacia is also encountered.