Neuro_MR_Brain: 47 M, intractable nausea and vomiting for 5 months, negative GI work-up. Increased lymphocytes and protein on LP

BRAIN MRI:

 

CLINICAL HISTORY: 

47-year-old male with intractable nausea and vomiting for 5 months. Extensive GI work-up has been negative. Lumbar puncture demonstrates increased lymphocytes and protein. 

 

FINDINGS: 

 

There is confluent abnormal T2 prolongation involving the mesiotemporal lobes, predominantly the hippocampi and perihippocampal gyri. There is partial enhancement of these areas of abnormal 

signal. There are no areas of restricted diffusion. There is no intracranial hemorrhage. Multivoxel MR spectroscopy demonstrates a few voxels with increased choline relative to creatine and NAA. 

 

The ventricles, sulci, and cisterns are normal in size and appearance. There is no midline shift. 

 

There is focal left maxillary sinus mucoperiosteal thickening or a retention cyst. The remainder of the visualized paranasal sinuses are clear. Orbits and calvarium are unremarkable. 

 

IMPRESSION: 

 

Symmetric mesiotemporal abnormal T2 prolongation and enhancement. Differential diagnosis includes a viral or limbic encephalitis and less likely lymphoma.

(Limbic encephalitis)