Herpes encephalitis

Case contributed by Abdallah Alqudah
Diagnosis almost certain


Confusion, fever and headache.

Patient Data

Age: 60 years
Gender: Female

Area of high signal intensity depicted on T2 and FLAIR seen in the left temporal lobe medially extending to the left perisylvian cortex, inferior frontal gyrus and left dorsal thalamus, with relative sparing of the left basal ganglia. This area showed a patchy area of diffusion restriction on diffusion images, and non-enhancing post contrast administration, appearances are suggestive of herpes encephalitis, acute infarction is another differential please correlate clinically and with lab results and follow-up brain MRI.

Case Discussion

The patient presentation with confusion and fever, the MRI findings and the lumbar puncture result of lymphocyte predominant leukocytosis make the diagnosis of encephalitis (mostly herbitic) almost certain.

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