PMC5949951_01
Magnetic resonance imaging of case 1.. (a) T2-MRI on day 15 after disease onset shows oedema in the left temporal lobe and the surrounding tissue; (b) T2-MRI at the time point of NMDAR-positive testing shows no further changes; (c) T2-MRI at discharge shows atrophy and gliosis in the left temporal lobe; (d) T1-MRI on day 15 shows normal ventricular size and mild dilatation of the left Sylvian fissure; (e) T1-MRI at NMDAR encephalitis diagnosis shows no further changes in comparison with the previous one; (f) T1-MRI at discharge shows a significant dilatation of the lateral and third ventricles and subarachnoid space.. T1, ; T2,; MRI, magnetic resonance imaging; NMDAR, N-methyl-D-aspartate receptor.
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The magnetic resonance imaging (MRI) on day 15 showed a haemorrhagic lesion in the left temporal lobe (Figure 1a, 1d). MRI did not show significant changes (Figure 1b, 1e); repeated PCR for HSV remained negative. Brain MRI at discharge showed significant dilatation of subarachnoid spaces with enlargement of the third and lateral ventricles (Figure 1f); the prior haemorrhagic lesion in the left temporal lobe related to HSV-1 infection remains now as a gliotic area (Figure 1c).
Magnetic resonance imaging of case 2.. (a), (b) T2-weighted-images show high-signal intensity and oedema in the left temporal and occipital lobes; (c), (d) Follow-up MRIs show areas of necrotic lesions in the same regions, seen on T1-weighted images (c) and T2 (d).. T1, ; T2,; MRI, magnetic resonance imaging.
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Brain MRI revealed the presence of increased T2-MRI signal diffusely at the left temporal and occipital lobes (Figure 2a, 2b), consistent with the diagnosis of HSV encephalitis. Follow-up brain MRI, performed 1 month after immunotherapy, revealed areas of necrotic lesions mainly at the temporal and occipital lobes (Figure 2c, 2d).