Fever for 4-5 days. Altered sensorium and vomiting.
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Hyperintense signal on T2 and FLAIR images involving bilateral thalami, caudate nuclei, pons, midbrain, left occipital lobe and bilateral cerebellar hemisphere. Patchy focal areas of blooming are seen within the thalami and pons, suggestive of hemorrhage. Basilar artery flow void is maintained on T2 images. Venography showed no thrombosis of the internal cerebral vein or straight sinus.
Japanese encephalitis still remains a major health problem in India and South-East Asia. Clinical history with typical MRI features showing bilateral thalamic involvement are pivotal in diagnosis.