Case 33 - Herpes Encephalitis in Lung Cancer Patient: MRI

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

MRI OF THE HEAD WITH AND WITHOUT CONTRAST

MRA OF THE HEAD WITHOUT CONTRAST

INDICATION: stroke v met. 73 y.o. man with arthritis and a recent diagnosis of colon cancer stage 3, admitted to Neurology for HSV meningoencephalitis.

COMPARISON: CT head without contrast 5/12/2017 and 5/14/2017.

TECHNIQUE: Multiplanar multisequence MRI of the brain without contrast. DWI images and ADC maps are available. MRA of the circle of Willis time-of-flight. MIPs and reconstructions are available. 3D reconstructions were created.

FINDINGS:

T2/FLAIR hyperintensity and mild expansion involving the the medial aspect of the temporal lobe, uncus and hippocampus bilaterally, slightly more prominent on the right, extending into the anterior temporal lobe greater on the right. There is corresponding restricted diffusion, but without signal loss on SWI images to suggest hemorrhagic changes. There is no enhancement on postcontrast images.

Moderate scattered periventricular T2/FLAIR hyperintensities are non specific but most likely represent chronic microvascular ischemic changes.

Mild cerebral and cerebellar volume loss is appreciated, with corresponding mild dilatation of the ventricular system. No hydrocephalus is identified.

No abnormal intra or extra axial fluid collection is present.

Orbits are normal.

Scalp and calvarium are normal.

The paranasal sinuses and lesser cells are grossly unremarkable.

MRA of the head:

Motion artifact degrades the images, but the circle of Willis is patent without high-grade stenosis or large aneurysmal dilatation. The left P1 segment is hypoplastic. The left posterior communicating artery is prominent and gives origin to the left posterior cerebral artery, consistent with fetal origin. The vertebral arteries and basilar artery are patent.

IMPRESSION:

MR brain:

1. Mild expansion with signal abnormalities involving the medial and right greater than left anterior temporal lobe gyri, uncus and hippocampus bilaterally, slightly asymmetric, right greater than left, compatible with diagnosis of herpes encephalitis.

No evidence of hemorrhage.

MRA of the head:

1. Motion artifact degrades the images, but the circle of Willis appears patent without high-grade stenosis.