case_images: PMC6601122_01
case_images: Axial (A) and coronal (B) T2-weighted MRI showing swollen, hyperintense, insular cortices (thick black arrows), cingulate gyri (black arrowheads), and basal temporal cortices (thin black arrows). Follow-up axial fluid-attenuated inversion recovery MRI at 6 months showing resolution of old changes with residual mild cortical atrophy, ex vacuo ventricular dilatation, and curvilinear hyperintense signal changes in subcortical white matter of insular and frontal cortex (C)
case_images: JPN-14-36-g001.jpg
case_images: PMC6601122_01_JPN-14-36-g001.jpg
case_images: F1
case_images: On the basis of the MRI of the brain [Figure 1A and B], a diagnosis of herpes encephalitis was suspected and treatment with acyclovir initiated. MRI revealed residual changes and no new areas of involvement [Figure 1C]. His initial diagnosis of herpes encephalitis [Figure 1] was revised to late-onset citrullinemia type I.