PMC4392527_01
Preoperative axial T2WI MRI showing encephalomalacia involving the anterior and mesial aspect of the right temporal lobe, right frontal operculum, and right insula
SNI-6-47-g001.jpg
PMC4392527_01_SNI-6-47-g001.jpg
F1
Preoperative magnetic resonance image (MRI) showed an area of encephalomalacia involving the anterior and mesial aspect of the right temporal lobe, right frontal operculum, and right insula [Figure 1], which correlates with concordant hypometabolism on F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET).
Immediate postoperative axial T2WI MRI revealing right temporal lobectomy, amygdalo-hippocampectomy and right frontal lobe disconnection with no evidence of complications
SNI-6-47-g002.jpg
PMC4392527_01_SNI-6-47-g002.jpg
F2
Postoperative MRI showed expected postoperative changes with no complication [Figure 2].
(a-b) Postoperative axial MRI on the 10th POD showing extensive cytotoxic edema with restricted diffusion in the right fronto-orbital, insular, and posterior frontal cortex. (c-d) Serial postoperative axial MRI showed extensive cytotoxic edema involving the right fronto-parietal-temporal and insular cortex, right thalamus, and left fronto-insular cortex
SNI-6-47-g003.jpg
PMC4392527_01_SNI-6-47-g003.jpg
F3
A repeat CSF study was normal but follow-up MRI showed extensive cytotoxic edema with restricted diffusion in the right fronto-orbital, insular, and posterior frontal cortex [Figure 3a and b]. Serial MRI showed progression of the signal changes revealing at the end extensive gray and white matter disease with patchy enhancement in both cerebral hemispheres, worse in the right side extending into the right basal ganglia, thalamus and pons [Figure 3c and d].
(a-d) Axial MRI performed 4 weeks after surgery revealing extensive gray and white matter disease with patchy enhancement in both cerebral hemispheres, worse in the right side, extending into the right basal ganglia, thalamus and pons
SNI-6-47-g004.jpg
PMC4392527_01_SNI-6-47-g004.jpg
F4
MRI performed 1-month following surgery revealed persistent changes of the right hemisphere and left frontal lobe [Figure 4].
Pathology revealing encephalomalacia of cortex characterized by cystic degeneration/cavitation (a), astrocytic gliosis with microglial nodules (b), perivascular lymphocytic monocyte cuffing (c) and reactive gliosis (d). There are no viral inclusion bodies. There is pyramidal neuronal loss in hippocampus
SNI-6-47-g005.jpg
PMC4392527_01_SNI-6-47-g005.jpg
F5
These findings were consistent with chronic encephalitis [Figure 5].