Presentation
Two days of headache followed by GTCS.
Patient Data
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.
Conclusion:
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.
Case Discussion
Patient proceeded to lumbar puncture and on PCR, HSV-1 DNA was detected. Patient was immunosuppressed for a renal transplant.
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