PMC5045948_01
Herpes simplex encephalitis. MRI brain at one month (top left, top right) and one year (bottom left, bottom right) following the initial presentation. T1 with contrast axial (top left) and coronal (top right) images taken one month after the initial presentation showing enhancement in the left temporal lobe and subinsular cortex as well as signal abnormality in the right and left insular cortices. T2 without contrast axial (bottom left) and coronal (bottom right) images taken at one year when the patient presented with transient recrudescence of his symptoms.
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An MRI, repeated two weeks later, showed enhancement of the left temporal lobe and bilateral insular cortices (Fig. 1 top left and top right). His symptoms resolved within hours without anti-viral treatment and a non-contrast MRI demonstrated only left temporal lobe encephalomalacia (Fig. 1 bottom left and bottom right), which was felt to be sequelae of his prior HSE.
Acute retinal necrosis. Fundus photograph (left) showing retinal whitening, vascular occlusion, numerous retinal hemorrhages and disc edema. Flourescein angiogram (right) showing leaking and staining of the central retinal arterioles and venules and severe peripheral nonperfusion consistent with occlusive vasculitis.
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His fundus exam revealed mild vitritis, retinal whitening, vascular sheathing and peripheral choroidal effusions (Fig. 2 left). Fluorescein angiography demonstrated occlusive vasculitis (Fig. 2 right).