case_images: PMC7578717_01
case_images: Axial magnetic resonance images (MRIs) demonstrating bright signal intensity and gyriform swelling in the region of the uncus (a) and thalami and insular cortex (b). This is best appreciated on flair images (c) and is harder to detect on T2-weighted images. The contrast study (d) does not show enhancement.
case_images: CRIM2020-2074704.001.jpg
case_images: PMC7578717_01_CRIM2020-2074704.001.jpg
case_images: fig1
case_images: The brain MRI with contrast showed multiple areas of bright signal intensity throughout the brain parenchyma, most notably in the medial temporal lobes and bilateral insular cortices, compatible with encephalitis (Figure 1).
case_images: Axial magnetic resonance images (MRIs) one and a half weeks after treatment with immunoglobulin and methylprednisolone demonstrating gyriform swelling of the temporal lobes (a), especially medially, best seen on flair sequences (a, c, d). There is a faint bright signal intensity observed in the bilateral thalami and basal ganglia (c). Vague cortical brightness is also seen. There is no evidence of abnormal contrast enhancement (b). Compared to the earlier study, the degree of bright signal intensity is decreased, though swelling remains. These findings, with cortical, thalamic, and basal ganglia involvement, are typically seen in encephalitis.
case_images: CRIM2020-2074704.002.jpg
case_images: PMC7578717_01_CRIM2020-2074704.002.jpg
case_images: fig2
case_images: Repeat MRI after two weeks showed decreased bright signal intensity, although swelling remained the same (Figure 2).