9 year old boy with headache, fever and seizures.
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See below. enlargement and hyperintense T2/FLAIR signal in the hypothalamic region, frontal, temporal lobes and bilateral insular cortex. Leptomeningeal enhancement.
Herpetic encephalitis is associated with Herpes Simplex Virus (HSV) type 1 and 2. Patients have fever, headaches, seizures, etc. The diagnosis is confirmed by cerebrospinal fluid PCR. Patients presents with fever, headache, focal neurological symptoms, seizures, altered electroencephalogram and focal lesions on the MRI. CT is usually normal, though it may present with low density lesions and mass effect in the temporal lobes. MRI shows edema, high intensity signal on temporal and frontal lobes, as well as on the insular cortex (T2 and FLAIR). The use of gadolinium does not enhance lesions on the early stages of the disease. The thalamus and the basal ganglia can also be affected.
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