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Lumbar puncture was performed – herpes simplex virus DNA was not shown on polymerase chain reaction. This axial diffusion-weighted MR image shows high signal in the cortex of the temporal lobes and insula, much more marked on the right. You must have a high index of suspicion, a good plan for your work-up, and rapid provision of treatment.


The calculated apparent diffusion coefficient map (click image) confirms restricted cortical diffusion and shows increased diffusion in the underlying white matter. After seeing a severely ill meningitis patient, I figured I would do a podcast on some tips and pearls on this topic.
The differential diagnoses include limbic encephalitis (paraneoplastic), gliomatosis cerebri, and status epilepticus.





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Comments
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