Presentation
Acute onset fever, headaches
Patient Data
MRI shows prominent hyperintense signal on T2, FLAIR, DWI involving the bilateral insular cortex, hippocampus, medial and anterior temporal lobes. The basal ganglia are spared.
There is no hemorrhage, abnormal enhancement, or mass effect.
Note: image quality degraded due to motion artifacts.
Case Discussion
The symptoms and MRI features are suggestive of herpes simplex encephalitis. The differential diagnosis includes stroke, limbic encephalitis, tumor. The symptoms and classic distribution of lesion are helpful in distinguishing from infarction or limbic encephalitis. The restricted diffusion, subtle mass effect, predilection for grey matter can differentiate it from the neoplasm. The other viral encephalitides are difficult to separate clinically, and the diagnosis usually requires PCR of CSF.
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