PMC6739592_01
(A-F): Brain MRI images at first presentation with HSV encephalitis.. A: FLAIR coronal image demonstrating gyral oedema and hyperintensity predominantly involving the right insular cortex and the right medial temporal lobe. Fig. 1B: Diffusion weighted axial image showing a linear area of hyperintensity involving the right insular cortex suggestive of diffusion restriction. Fig. 1C: Susceptibility weighted axial image revealing presence of petechial haemorrhage in the right insular cortex. Fig. 1D: Post gadolinium T1W coronal image demonstrating mild patchy gyral enhancement in the insular cortex. Fig. 1E and F: A rounded rim enhancing lesion with marked perilesional vasogenic oedema is shown at the right centrum semiovale keeping with the known brain metastasis from small cell lung cancer.
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Brain MRI was performed (Fig. 1).
(A and B): Brain MRI images at time of relapse of HSV encephalitis.. A: Diffusion weighted axial image revealing new cortical signal abnormality with diffusion restriction involving the right inferior temporal gyrus and both hippocampi. Fig. 2B: FLAIR axial image demonstrating worsening of the right temporal lobe hyperintensity compared to the previous MRI.
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MRI brain (Fig. 2) and EEG (Fig. 3) are depicted below.