MRI Brain (selected series)
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Right temporo-insular T2 hyperintensity.
This is associated with gyral and possibly leptomeningeal enhancement in the anterior temporal pole and anterior insula.
No associated diffusion restriction or convincing CBV increase (not shown). Spectroscopy shows moderate choline elevation (not shown).
Left hippocampal formation demonstrates subtle FLAIR hyperintensity, raising the possibility of contralateral involvement.
Remainder of the brain is normal.
No region of diffusion restriction to suggest acute infarct.
Incidental right maxillary sinus mucous retention cyst.
Conclusion: Imaging differential diagnosis has not significantly changed. Limbic-encephalitis is favoured over herpes simplex encephalitis on clinical grounds.
Although still an imaging possibility, the pattern of enhancement is not classic for glioma.