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CB1236

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Case Notes

History

75 yo male with multiple clinical problems (HTN, coronary artery disease) who presented with shortness of breath, nausea and confusion followed by seizures.

Exam

Prior Study

MR flair
1. Right cerebral cytogenic edema in the right cerebrum with a distribution consistent with acute herpes simplex encephalitis.
2. Non aggressive mucosal changes in the paranasal sinuses and otomastoid air cells.

Pre and post contrast T1-w MR
1. Abnormal contrast enhancement with leak of contrast into the most affected portions of the herpes related cytogenic edema. The contrast leak is mainly in the insula and anterior temporal lobes. This does indicated cytogenic membrane damage causing an inflammatory response. 
2. There is no enhancement of the otomastoid or paranasal sinus mucosa to suggest aggressive disease.

MR diffusion
1. MR diffusion (DWI map) of more cortical involvement by the herpes encephalitis than evident on the MR flair. Findings are typical of the limbic distribution of herpes simplex-1 encephalitis.

Dicom

 
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CB1236

Findings

MR susceptibility (SWI)

There is evidence of pial microhemorrhage.

There is evidence of parenchymal or subependymal microhemorrhage.

There is evidence of pial arterial inflammatory hyperemia.

There is evidence of increased deep medullary venous drainage from inflammatory hyperemia.

There is evidence of reduced pial arterial size consistent with pial vasospasm.

There is evidence of reduced or absent deep venous filling consistent with metarteriole vasospasm.

There is evidence of arterial and venous hyperemia consistent with an AV fistula.

There is evidence of venous blooming effect associated the venous stasis.

No other significant imaging findings are present.