PMC4302184_01
Brain fluid attenuated inversion recovery imaging performed before surgery showing a diffuse hyperintense signal within the medial temporal lobes and extending into the basal ganglia, frontal basal lobes, and leptomeninges (A). Avid and homogeneous enhancement was noted after administration of contrast medium (B).
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F1
MRI demonstrated diffuse hyperintensities in the parenchyma, with predominantly medial bitemporal involvement extending into the basal ganglia, frontal lobes, and leptomeninges on FLAIR images, which is the most characteristic sequence, suggesting a PLE (Fig. 1).
Brain fluid attenuated inversion recovery imaging performed after surgery depicting remarkable decreases in the extension and signal intensity within the medial region of both temporal lobes. Secondary mesial atrophy with temporal horn dilatation can be observed (A). No enhancement was observed after gadolinium injection (B).
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F2
Secondary mesial atrophy with temporal horns dilatation was observed (Fig. 2).
Histologic images of postmortem brain tissue showing a prominent atrophy of the anterior part of the hippocampus at low magnification (A) (hematoxylin-eosin stain) with marked segmental neuronal loss and loosening of the neuropil (arrows). At higher magnification, prominent reactive gliosis with abundant large gemistocytes (B1), some mineralizations (B1), and parenchymal and perivascular inflammatory cuffs (B2) were observed. Most of the parenchymal infiltrates were composed of CD8-positive T-cells (C), some of which were in close contact with morphologically intact neurons (arrows) (D).
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F3
In the brain, the autopsy confirmed advanced bilateral T-cell-mediated limbic encephalitis with persistent inflammatory activity (Fig. 3) extending to the midbrain tectum.