case_images: PMC11732269_01
case_images: Brain magnetic resonance imaging showing extensive loss of gray-white matter differentiation and parenchymal swelling predominantly involving the left frontal lobe, with lesser involvement of the left medial thalamus, right medial frontal lobe, and cortical-subcortical regions of the bilateral parietal lobes . There are patchy areas of involvement in the cortical temporal lobes, accompanied by diffuse cortical swelling and T2/fluid-attenuated inversion recovery (FLAIR) signal alteration. Additionally, cystic encephalomalacia with gliosis is observed within the bilateral parietal, temporal, and occipital lobes, extending into the bilateral temporal lobes, more prominently on the right side. Postcontrast imaging shows diffuse cortical/pachymeningeal enhancement extending bilaterally to the tentorial leaflet. The images are T2-weighted (A), FLAIR images (B), diffusion-weighted imaging (C), and contrast-enhanced T1-weighted (D).
case_images: encephalitis-2024-00101f1.jpg
case_images: PMC11732269_01_encephalitis-2024-00101f1.jpg
case_images: f1-encephalitis-2024-00101
case_images: Postcontrast imaging demonstrated diffuse cortical/pachymeningeal enhancement extending bilaterally to the tentorial leaflet (Figure 1).
case_images: Brain magnetic resonance imaging demonstrating significant swelling of the right frontal lobe, right insular cortex, left basal ganglia, and anterior corpus callosum, with marked loss of gray-white matter differentiation. There are T2 hyperintense foci in the left cerebral peduncle and left aspect of the midbrain/pons. The image also shows cortical atrophy and cystic encephalomalacia in the left frontal lobe, insular cortex, and areas of abnormal signal intensity in the left thalamus, with confluent T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity in the left frontal parenchyma. Additional findings include cortical atrophy and cystic encephalomalacia in the bilateral parietal, temporal lobes, and hippocampi. Postcontrast imaging shows heterogeneous cortical and subcortical enhancement. The images are T2-weighted (A), FLAIR images (B), diffusion-weighted imaging (C), and contrast-enhanced T1-weighted (D).
case_images: encephalitis-2024-00101f2.jpg
case_images: PMC11732269_01_encephalitis-2024-00101f2.jpg
case_images: f2-encephalitis-2024-00101
case_images: New hyperintense foci were noted in the left cerebral peduncle and left midbrain/pons, raising concerns for acute necrotizing encephalopathy rather than primary disease recurrence (Figure 2).
case_images: Brain magnetic resonance imaging illustrating extensive gliosis and cystic encephalomalacia involving the bilateral frontal and insular regions, bilateral temporal and parietal lobes, insular cortex, hippocampi, left basal ganglia, and anterior corpus callosum . There is also evidence of global brain volume loss with ventriculomegaly. Postcontrast imaging shows no new enhancement. The images are T2-weighted (A), fluid-attenuated inversion recovery images (B), diffusion-weighted imaging (C), and contrast-enhanced T1-weighted (D).
case_images: encephalitis-2024-00101f3.jpg
case_images: PMC11732269_01_encephalitis-2024-00101f3.jpg
case_images: f3-encephalitis-2024-00101
case_images: A subsequent MRI 1 month later revealed evolving bilateral multifocal cerebral parenchymal cystic encephalomalacia and gliosis with hemosiderin deposition and without new diffusion restriction or enhancement (Figure 3).