Findings
- Extensive T2/FLAIR hyperintensity and gyral swelling involving the right temporal lobe including the right parahippocampal gyrus with extension into the inferior right frontal lobe, right insula, and dorsomedial right thalamus
- Associated predominantly cortical restricted diffusion
- No associated hemorrhage or enhancement
- Mild local mass effect without midline shift, herniation, or hydrocephalus
- Remote right cerebellar lacunar infarct
- Few scattered subcortical and periventricular white matter hyperintensities
- Small mucous retention cyst in the inferior aspect of the right maxillary sinus
Diagnosis
Herpes encephalitis
Sample Report
Findings are primarily concerning for encephalitis involving the right temporal lobe, inferior right frontal lobe, right insula, and dorsomedial right thalamus, which given distribution is particularly concerning for herpes encephalitis. Recommend presumptive treatment awaiting CSF analysis. A low grade glioma could also have this imaging appearance, though the associated areas of restricted diffusion would be less typical for this entity. Nonetheless, recommend follow-up imaging after treatment to ensure resolution.
Mild local mass effect without midline shift, herniation, or hydrocephalus.
No acute hemorrhage.
Few scattered subcortical and periventricular white matter hyperintensities, which are nonspecific but commonly attributable to chronic small vessel disease.
Discussion