PMC8769415_01
Preoperative and postoperative MRI results of the patient with long-term recurrent encephalitis due to herpes simplex virus. (a) Preoperative MRI FLAIR shows atrophic changes in the right temporo-parieto-occipital lobe. (b): On POD 1, MRI shows ICH in the sylvian fissure and FLAIR hyperintensity around ICH. (c) On POD 8, MRI shows subtle FLAIR hyperintensity in the right frontal lobe (white arrow). (d) On POD 73, MRI reveals FLAIR hyperintensity in the bilateral frontal lobe, including the white matter (white arrows). (e) On POD 100, we performed brain biopsy targeting the right frontal lobe FLAIR hyperintensity lesion. FLAIR: fluid-attenuated inversion recovery, ICH: intracerebral hemorrhage, MRI: magnetic resonance imaging, POD: postoperative day.
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MRI revealed right temporo-parieto-occipital lobe atrophy (Fig. 1a). The MRI demonstrated an intracerebral hemorrhage (ICH) in the right Sylvian fissure and fluid-attenuated inversion recovery (FLAIR) hyperintensity surrounding the ICH (Fig. 1b). On POD 8, the FLAIR hyperintensity had spread including to the right frontal lobe (Fig. 1c) and her consciousness had worsened. On POD 73, FLAIR revealed bilateral hyperintensity in the frontal lobes, including the white matter (Fig. 1d). To confirm the diagnosis, we performed a brain biopsy of the cortex and white matter, targeting the FLAIR hyperintensity lesion in the right frontal lobe on POD 100 (Fig. 1e).
Histopathology of biopsied brain specimen from the patient with long-term recurrent encephalitis due to herpes simplex virus. (a) The white matter lesions show vacuolar degeneration and include hypertrophic reactive astrocytes (hematoxylin and eosin staining). (b) The small vessel with many lymphocytes (perivascular lymphocyte cuffing) in the white matter lesion (hematoxylin and eosin staining).
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The white matter showed vacuolar degeneration with many reactive astrocytes (Fig. 2a). Small vessels in the lesion were involved in perivascular lymphocyte cuffing (Fig. 2b).