Neuro_MR_Brain: 70 M, rapidly progressive cognitive decline.

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 70-year-old male with rapidly progressive cognitive decline and myoclonus, concern for CJD.

FINDINGS:

Parenchyma: No acute hemorrhage, infarction, or mass. Right hippocampal T2/FLAIR signal abnormality with increased ASL signal / cerebral blood flow in that area. There is no associated diffusion restriction or susceptibility blooming within the right hippocampus. Scattered white matter T2/FLAIR signal abnormality, which is nonspecific but may reflect chronic small vessel ischemic changes.

Ventricles and extra-axial spaces: Appropriate for age.

Orbits: Normal.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: None.

IMPRESSION:

1. T2/FLAIR signal abnormality with increased perfusion in the right hippocampal region. Diagnostic considerations include limbic encephalitis, which can be paraneoplastic especially if the patient has a history of or risk factors for malignancy. HSV encephalitis is considered unlikely given the lack of swelling or other infectious signs in the mesial temporal lobe.

(Limbic encephalitis)