Herpes simplex encephalitis

Case contributed by Dr Huda B. Gharbia

Presentation

Fever, loss of consciousness

Patient Data

Age: 4 years
Gender: Male
MRI

Bilateral swelling and hyperintensity of  insula, peri-sylvian region, inferior right frontal lobe, in both T2Wi and FLAIR sequences, restricted diffusion in DW/ADC, and show leptomeningeal enhancement in T1Wi post contrast.

Also noted hyperintense areas in both thalami in bothT2W and FLAIR sequences.

Case Discussion

Abnormal high signal intensity in T2W and FLAIR sequences involving cortex and underlying white matter of temporal lobes, insula, peri-sylvian regions, sparing the lentiform nuclei, leptomenigeal enhancement, cytotoxic edema, suggestive inflammatory process, probable herpes encephalitis.

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