Neuroradiology #17 – Long case

Regarding the following images:

Where is the abnormality?

Bilateral asymmetrical temporal and inferomedial frontal lobes and insular cortices

What is it like?

Abnormal CT hypodensity and high FLAIR signal intensity of the affected white matter and cortex

What is the differential diagnosis?

Herpes encephalitis: affects the limbic system bilaterally, temporal lobes, insular cortices and inferolateral frontal lobes. May progress to hemorrhage. Basal ganglia is typically spared

Paraneoplastic tumor-related limbic encephalitis and autoimmune limbic encephalitis: tumour-related limbic encephalitis and autoimmune limbic encephalitis: autoimmune encephalitis. Same distribution as herpes encephalitis but the basal ganglia is frequently involved. Hemorrhage is uncommon

What is the final diagnosis?

Herpes encephalitis

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