Fever and headache starting a week ago.
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Increased density in the hippocampus and the left temporal lobe on T2-weighted and FLAIR sequences.
Restriction of diffusion in DWI.
T1 shows oedema of the limbic system and left medial temporal lobe. Hyperintensity affected white matter and cortex on FLAIR in these areas. Restricted diffusion on DWI and ADC.
These findings described in the clinical context, are compatible with herpes encephalitis.
The main differential diagnosis:
- other viral encephalitides
- limbic encephalitis
- gliomatosis cerebri
- status epilepticus
- middle cerebral artery (MCA) infarction