Presentation
Disturbed level of consciousness and mild fever.
Patient Data
Subtle hypodensity in the right medial temporal lobe.
The right medial temporal lobe shows patchy areas of restricted diffusion with high diffusion-weighted image (DWI) and as well as hypointense T1 and hyperintense T2 and FLAIR signal intensity. The lesion is seen involving the claustrum as well but with preservation of the putamen.
Atrophic brain changes with periventricular atherosclerotic leukoencephalopathy as well as bilateral cerebral deep white matter centrum semiovale and corona radiata patchy and confluent demyelinating lesions with high T2 and FLAIR signal intensity.
No mass lesion or area of recent blood signal intensity.
No gross posterior fossa abnormality. Normal sellar region.
Bilateral mastoiditis more evident on the right side with T2 prolongation.
Case Discussion
The above described findings are consistent with herpes simplex virus (HSV) encephalitis.
Atrophic brain changes with periventricular atherosclerotic leukoencephalopathy and bilateral cerebral demyelinating foci consistent with chronic lacunar infarctions or chronic small vessel disease.
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