Right temporal lobe exhibits high T2/FLAIR and low T1 signal intensity, extending to the right insular cortex, hippocampal, parahippocampal gyrus, and anteroinferior right occipital lobe with swollen gyrus, effacement of surrounding sulci and right occipital horn of lateral ventricle.
Additionally, the left mesial temporal lobe and insular cortex showed high T2/FLAIR and low T1 signal intensities, along with involvement of the bilateral lower paramedian frontal lobes.
Restricted diffusion is more subtle than infarction in the areas of the brain where the signal intensity changes.
Neither hemorrhagic nor enhanced lesions were visible.
The bilateral basal ganglia remain unaffected.
There is no evidence of hydrocephalus.
Bilateral maxillary sinus mucosal high T2, low T1 with no enhancement detected suggesting its fluid—common accidental observations.
CONCLUSION
Herpes simplex encephalitis is suspected based on the patient's history of headaches and behavioral changes lasting five days, as well as imaging results showing bilaterally asymmetric involvement of the medial temporal lobe, insular cortices, and infero-medial frontal lobe.