Patient History
Not following commands, fever, post-ictal
Findings
INDICATION: not following commands, fever, post-ictal
COMPARISON: No prior MRI brain available for comparison. CT head performed on 11/3/2021.
TECHNIQUE: Multiplanar multisequence pre and post contrast MR sequences through the head/brain.
CONTRAST: 8.5mL Gadavist IV.
BRAIN FINDINGS:
Enhancement of the mesial left temporal lobe with corresponding T2 / FLAIR hyperintensity and restricted diffusion. In addition, there is T2 FLAIR hyperintensity of the cingulum on the left side, best seen on series 6 image 17. The posterior gyrus rectus on the left side is also affected. This also corresponds to area susceptibility representing hemorrhagic transformation in the mesial temporal lobe which was also seen on the prior CT as demonstrated by corresponding area of hyperdensity.
Prominent ventricles and sulci are seen representing cerebral volume loss, unchanged from the prior CT. Overlying the high left frontal convexities there is high signal inteabsence of suppression.
There are no other areas of restricted diffusion. No other areas of intraparenchymal hemorrhage.
Status post bilateral lens extraction. Mucosal thickening of the medial paranasal sinuses. No effusion seen in the mastoid air cells. Calvarium is intact.
Impressions
Enhancement of the left mesial temporal lobe and left cingulum with adjacent T2 FLAIR hyperintensity compatible with HSV 1 encephalitis. Absence of suppression of the parietal convexities compatible with meningitic component. Hemorrhagic transformation is present, unchanged compared to the prior CT.
