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The hippocampal head and the medulla, and to a lesser degree, hippocampal body on the right demonstrate increased T2 signal and appear bulkier than the counterpart on the left. There is increased DWI signal, without convincing facilitated diffusion on ADC; some areas demonstrate slight reduction in ADC values. There is apparent faint enhancement within the inferior amygdala only seen on coronal images which is not categorically a real finding.
MR perfusion appears symmetric. MR spectroscopy is noncontributory.
Swelling increased T2 signal of the right hippocampus and amygdala has a differential of infiltrating tumour and limbic encephalitis (e.g. paraneoplastic). Limited, if any, change over the previous two weeks both on imaging and clinical status, makes herpes encephalitis very unlikely. The changes are too pronounced to represent post-seizure effects.