Herpes simplex encephalitis
Two days of headache followed by GTCS.
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High signal FLAIR / T2 signal is demonstrated within the right mesial temporal lobe associated with mild gyral expansion, sulcal effacement and restricted diffusion.
Equivocal high FLAIR/T2 signal is also seen at the left mesial temporal lobe, with lesser positive mass effect, and no convincing restricted diffusion.
Apart from a few scattered white matter high foci, the remainder of the examination is within normal limits. No hydrocephalus. No susceptibility artefact.
Given the history of fever and seizures coupled with the MRI findings of bilateral mesial temporal lobe changes, herpes encephalitis requires clinical consideration.
Differentials include post-ictal changes, with other differentials such as neoplastic causes thought less likely.
Patient proceeded to lumbar puncture and on PCR, HSV-1 DNA was detected. Patient was immunosuppressed for a renal transplant.