Demographics:
83 years old, Male
Indication:
Acute encephalopathy
Findings
- Multifocal T2/FLAIR signal hyperintensity and restricted diffusion involving the right temporal lobe, right greater than left hippocampi, right greater than left cingulate gyri, and right insula with mild gyral swelling and local mass effect
- Small area of intrinsic T1 signal hyperintensity in the right inferior temporal gyrus with corresponding susceptibility artifact
- No evidence of midline shift, herniation, or hydrocephalus
- Bilateral parietal-predominant cerebral volume loss with pronounced enlargement of adjacent right parietal sulci
- Remote left cerebellar lacunar infarct
- Patchy subcortical and periventricular T2/FLAIR hyperintensities
- Bilateral mastoid effusions
- Left pseudophakia
Diagnosis
Herpes encephalitis
Sample Report
Restricted diffusion and edema involving the right temporal lobe, right greater than left hippocampi, right greater than left cingulate gyri, and right insula with a small area of petechial hemorrhage in the right temporal lobe. This appearance is most concerning for herpes encephalitis. Recommend presumptive treatment awaiting CSF analysis.
No evidence of midline shift, herniation, or hydrocephalus.
Background of parietal-predominant cerebral volume loss and small vessel disease. Remote left cerebellar lacunar infarct.
Bilateral mastoid effusions, which though nonspecific can be seen with mastoiditis.
Discussion