PMC5960559_01
64-year-old female with confusion, right lower extremity weakness, and questionable encephalitis. Axial FLAIR MR image (a) shows increased signal intensity and gyriform swelling in the cortex and subcortical white matter of the left parietooccipital lobe and a focus in the left thalamus. Diffusion weighed (b) and attenuation diffusion coefficient, ADC, MR images (c) reveal mild decreased diffusivity. No susceptibility artifact or contrast enhancement is observed on axial susceptibility weighted image, SWI (d), and axial T1 weighted (e) and axial T1 weighted postgadolinium images (f), respectively.
CRIRA2018-3538645.001.jpg
PMC5960559_01_CRIRA2018-3538645.001.jpg
fig1
MRI of the brain showed left parietooccipital cortical swelling with decreased diffusivity and abnormal hyperintense signal on T2- FLAIR sequences, suggesting encephalitic etiology (Figure 1).
CT perfusion was performed 10 days after the initial MRI imaging. The postprocessed CT perfusion maps in axial plane at the level of the left parietooccipital cortical abnormality reveal increased cerebral blood flow (CBF) and cerebral blood volume (CBV) in the affected cortex on the left as compared to the normal brain parenchyma on the right. The time to peak (TTP) is decreased.
CRIRA2018-3538645.002.jpg
PMC5960559_01_CRIRA2018-3538645.002.jpg
fig2
CT perfusion of the brain showed increased cerebral blood volume (CBV) and cerebral blood flow (CBF) and corresponding decreased time to peak (TTP) in the left parietooccipital cortex as compared to the contralateral normal brain tissue (Figure 2).