CLINICAL HISTORY: 57 years of age, Female, follow-up HSV encephalitis.
Parenchyma: Extensive edema and swelling with increased T2 signal and diffusion restriction involving the entire right temporal lobe, hippocampus, ventral frontal lobe (right greater than left), right thalamus and posterior portion of the left hippocampus. Previously only the right temporal lobe, hippocampus, and insula were involved. Mass effect on the right lateral ventricle is increased. Moderate subfalcine herniation with 7 mm of right to left midline shift, increased from minimal midline shift on prior. Increased uncal herniation, with mass effect on the midbrain. Progressive right hemispheric sulcal effacement.
Small focus of hemorrhage in the anterior right hippocampus.
Mildly decreased CBV and CBF but with normal T-Max, nonspecific.
Ventricles and extra-axial spaces: Small amount of intraventricular hemorrhage in the occipital horn of the right lateral ventricle.
Visualized paranasal sinuses: Clear.
Mastoid air cells: Clear.
Additional comment: None.
1. Interval increase in edema and swelling involving the right temporal lobe, bilateral hippocampi, and right greater than left frontal lobes and right thalamus with right medial temporal hemorrhage as well as intraventricular blood products in the right posterior horn. Moderate subfalcine and uncal herniation. Findings are concerning for significant worsening of reported known HSV encephalitis.