Presentation
Acute onset confusion with fevers.
Patient Data
Age: 60
Gender: Male
From the case:
Herpes encpehalitis
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There is asymmetry within the temporal poles, with loss of grey white matter differentiation on the left.
No evidence of intracranial hemorrhage or large vessel occlusion.
Case Discussion
Temporal pole hypodensity in a non-contrast study and a history of febrile episodes with disorientation/confusion may prompt further investigation with a lumbar puncture to rule out herpes simplex encephalitis.
In this case, herpes simple virus type 1 (HSV1) was positive on CSF analysis.
The differential diagnoses include ischemic stroke, limbic encephalitis, or a glial tumor.
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