PMC8496102_01
Axial FLAIR MRI image showing confluent hyperintense signal abnormality involving the bilateral thalamus, caudate and putamen.
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Repeat MRI showed increased foci of hyperintense FLAIR and T2 signal throughout the thalami and basal ganglia bilaterally with a band of increased signal extending along the medial aspect of the temporal lobes bilaterally (Fig. 1).
Confluent T2 hyperintense signal abnormality involving the bilateral thalamus, caudate, putamen and hippocampus.
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MRI scan showed more prominent changes consistent with diffuse encephalitis (Fig. 2).
Inferior medullary olive with neuronophagia and microglial nodules (A) that is highlighted by a CD68 (microglial/macrophage marker) immunostains (B). Patchy leptomeningeal and intraparenchymal perivascular lymphocytic infiltrates were present (C) and predominately consisted of CD3 cells (D). Organizing lesions were identified in the thalamus (E) that were characterized by collections of CD68-positive macrophages (F). The neocortex had patchy regions of active neuronophagia (G) characterized by macrophages surrounding individual neurons (H).
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Areas of active neuronophagia and scattered microglial nodules were present throughout, including the brainstem and neocortex (Fig. 3).