PMC6601122_01
Axial (A) and coronal (B) T2-weighted MRI showing swollen, hyperintense, insular cortices (thick black arrows), cingulate gyri (black arrowheads), and basal temporal cortices (thin black arrows). Follow-up axial fluid-attenuated inversion recovery MRI at 6 months showing resolution of old changes with residual mild cortical atrophy, ex vacuo ventricular dilatation, and curvilinear hyperintense signal changes in subcortical white matter of insular and frontal cortex (C)
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F1
On the basis of the MRI of the brain [Figure 1A and B], a diagnosis of herpes encephalitis was suspected and treatment with acyclovir initiated. MRI revealed residual changes and no new areas of involvement [Figure 1C]. His initial diagnosis of herpes encephalitis [Figure 1] was revised to late-onset citrullinemia type I.