PMC5414020_01
Brain magnetic resonance imaging (MRI) findings are depicted. Axial T2/fluid-attenuated inversion recovery MRI showing subtle hyperintensities in the basal ganglia and thalamus bilaterally (A) and in ventral pons (B) on hospital day 4.
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F1
Magnetic resonance imaging (MRI) showed subtle T2/fluid-attenuated inversion recovery (FLAIR) bilateral thalamic and basal ganglia hyperintensities (Figure 1).
Immunohistochemistry depicting inflammatory reaction and eastern equine encephalitis virus (EEEV) in the central nervous system are depicted. Perivascular and parenchymal chronic inflammatory infiltrates in a section of frontal cortex (A), consisting predominantly of CD3+ T lymphocytes (B) with no CD79a+ B lymphocytes (C). The EEEV is shown in neuronal cytoplasm in cortex (D), thalamus (E), and anterior horn cells in the thoracic spinal cord (F). Original magnification, x40 (E and F), x100 (D), and x200 (A-C); hematoxylin and eosin stain (A); immunostains CD3 (B), CD79 (C), and EEEV (D-F).
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F2
Microscopic examination showed collections of perivascular and parenchymal chronic inflammatory cells throughout the central nervous system and leptomeninges, comprised of CD3-positive T lymphocytes in the absence of B lymphocytes with minimal acute inflammation (Figure 2A-C). Infected neurons were present throughout the brain in a patchy, perivascular pattern, particularly in ischemic areas of the cortex and thalamus, as well as the anterior horn of the spinal cord (Figure 2D-F).