MRI: Bilateral Thalamic Hyperintensities

IMAGE OF THE WEEK

35 yr old female admitted with complaints of fever for past 3 days altered sensorium for past 2 days convulsions for past 1 day

PAST HISTORY: not a known DM/HT/EPILEPTIC/BAPERSONAL HISTORY: not a smoker/alcoholic mixed dietCONTACT HISTORY: no contact with TB

central nervous system: higher functions; E2 V2M5 pupils reacting equally ; ocr + motor system; moves al l four l imbs sensory system; couldn’t examined. cranial nerves; no cranial nerve involment terminal neck st if fness +; spine & cranium; normal

Other systems: normal.

T 1 shows - hypo intense lesion in thalamus.

T 2 shows- hyperintense lesion in thalamus,caudate nucleus and lentiform nucleus .

Fluid A ttenuated Inversion Recovery - lesions not

suppressed.

Bilateral thalamic gl ioma Wernicke s encephalopathy Osmotic myelinosis Wilson s disease Infections – west ni le, japanese encephalit is,rabies

eastern equine, murray val ley Vascular occlusion- venous

thrombosis,pregnancy,ocp, dehydration, trauma Fabry’s, fahr’s disease.

In the background of Acute CNS Infection MRI showing b/l thalamic hyperintensities Japanese Encephalitis, a strong possibility. The CSF serology confirmed it.

HSV ENCEPHALITIS

T 2 & FLAIR – hyperintensities in fronto orbital and temporal cingulate and insular region ;

WEST NILE ENCEPHALITIS,JE , RABIES ,

T2 & FLAIR – hyperintensities in thalamus basal ganglia & brainstem ;

VZV ENCEPHALITIS

Multifocal areas of hemorrhagic and ischemic infarcts (or) hyperintensities in basal ganglia

CMV ENCEPHALITIS

T2 hyperintensities in periventricular areas and enlarged ventricles

PML T2 & FLAIR -multifocal asymmetric periventricular hyperintense lesion in parietooccipital region and cerebellum

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