Herpes encephalitis, atypical

Findings:

Mutiple FLAIR and T1 postcontrast MR images demonstrate zones of cortical signal abnormality in nonvascular distributions of the bilateral frontal lobes, with no definite abnormal enhancement.

Differential diagnosis:

Nonspecific encephalitis, multiple infarcts due to vasculitis, multifocal primary glial neoplasm less likely.

Discussion:

The appearance is nonspecific. The patient was in status epilepticus and induced coma for 45 days. CSF analysis was supicious for HSV but never formally proven. Bilateral temporal lobe involvement would be more typical for HSV encephalitis.

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