Answer for CoW 08 Oct 2017
VIRAL ENCEPHALITIS
Findings
T2 /FLAIR bilateral symmetric hyperintensities involving both thalami and pons with few areas showing low ADC values. Central gradient blooming noted in both the above mentioned regions in SWI.
Discussion
Viral encephalitis is one of the most common cause of fatal encephalitis . Patients will usually present with altered consciousness, focal CN deficits, seizures, and other neurologic deficits, along with fever. T2 weighted MRI will usually reveal a unilateral increase in signal intensity in the temporal region, with cingulate and insulate gyri often involved. Isolated hyperintensity of the substantia nigra on T2-weighted images in patients with St. Louis Encephalitis. The thalamic lesions were characteristically bilateral and were haemorragic in Japanese encephalitis, Dengue, Influenza and Varicella Zoster. Changes on MRI included abnormalities of the brainstem , basal ganglia and spinal cord . Bilateral lentiform nucleus involvement, especially the putamen is seen in Cruztfield Jacob’ encephalitis. On following up our patient, it was found to be IgM positive for Dengue and hence we could narrow down finally as Dengue Encephalitis.
References:
http://www.ijri.org/article.asp?issn=09713026;year=2017;volume=27;issue=2;spage=125;epage=128;aulast=Soni https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510307/
Findings
T2 /FLAIR bilateral symmetric hyperintensities involving both thalami and pons with few areas showing low ADC values. Central gradient blooming noted in both the above mentioned regions in SWI.
Discussion
Viral encephalitis is one of the most common cause of fatal encephalitis . Patients will usually present with altered consciousness, focal CN deficits, seizures, and other neurologic deficits, along with fever. T2 weighted MRI will usually reveal a unilateral increase in signal intensity in the temporal region, with cingulate and insulate gyri often involved. Isolated hyperintensity of the substantia nigra on T2-weighted images in patients with St. Louis Encephalitis. The thalamic lesions were characteristically bilateral and were haemorragic in Japanese encephalitis, Dengue, Influenza and Varicella Zoster. Changes on MRI included abnormalities of the brainstem , basal ganglia and spinal cord . Bilateral lentiform nucleus involvement, especially the putamen is seen in Cruztfield Jacob’ encephalitis. On following up our patient, it was found to be IgM positive for Dengue and hence we could narrow down finally as Dengue Encephalitis.
References:
http://www.ijri.org/article.asp?issn=09713026;year=2017;volume=27;issue=2;spage=125;epage=128;aulast=Soni https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510307/
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!