PMC4750307_01
Right: Right-sided upper motor neuron type facial nerve palsy, Left: Magnetic resonance imaging of brain in T2 fluid attenuation inversion recovery sequence showing multiple tiny nonenhancings ischemic demyelination in lentiform nucleus, peri- and para- ventricular white matter and centrum semiovale on both sides
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F3
Right-sided upper motor neuron (UMN) type facial nerve palsy was noted [Figure 3, Right panel]. MRI scan of brain (plain and contrast) done on 6th day of fever, showed multiple tiny nonenhancing hypo on T1 and hyperintense lesions on T2, T2 fluid attenuation inversion recovery (FLAIR) sequence suggestive of ischemic demyelination in lentiform nucleus, peri- and para-ventricular white matter and centrum semiovale on both sides [Figure 3, Left panel].
PMC4750307_02
Magnetic resonance imaging scan of brain in T2 sequence showed non-enhancing altered signal intensity in both thalamic and left medial temporal lobe suggestive of encephalitis
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F4
T1, hyperintense in T2 and FLAIR) in both thalamic and left medial temporal lobe suggestive of encephalitis [Figure 4]. The patient was diagnosed as dengue meningoencephalitis.
PMC4750307_03
PMC4750307_04
Magnetic resonance imaging brain in T2 fluid attenuation inversion recovery sequence showed bilateral symmetrical hyperintensities in both thalamic regions
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F5
MRI brain (plain and contrast), done on the 6th day of fever, showed bilateral symmetrical T2 hyperintensities in both thalamic regions [Figure 5].
PMC4750307_05
Magnetic resonance imaging scan of brain T2 fluid attenuation inversion recovery sequence showed altered signal intensity in both thalamic and splenium of corpus callosum region
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F6
PMC4750307_06
PMC4750307_07
Upper: Magnetic resonance imaging of the brain in T2 sequence showing areas of hyperintensities involving bilateral periventricular and parietal region with signal changes involving right cerebellar peduncle with the involvement of upper brainstem. Lower Right, Middle, Left: Magnetic resonance imaging of spinal cord in T2 sequence showing hyperintense intramedullary signal changes involving spinal cord extending from C3 level downward including entire cervical (Lower Right Panel), thoracic (Lower Middle Panel), lumbar region until conus (Lower Left Panel) suggestive of myelitis with cord edema
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F7
C3 level downward until conus suggestive of myelitis with cord edema [Figure 7]. CSF study showed immunoglobulin synthesis index 0.72, immunoglobulin synthesis rate 6.5 mg/day with no oligoclonal bands.