Images in neuroscience
Images in neuroscience

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The most likely diagnosis: (MRI – T2-weighted spin echo, DWI, and axial post-contrast scans)

  • (a)

    Glioblastoma multiforme

  • (b)

    HSV encephalitis

  • (c)

    Progressive multifocal leukoencephalopathy

  • (d)

    Equine encephalitis

  • (e)

    Lymphoma

Answer

(b) HSV encephalitis

Other investigations

Lumbar puncture: 360 lymphocytes; HSV 1 PCR positive.

EEG: Generalised encephalopathy with slowing and occasional sharp theta transients in the right anterior temporal region.

Neuropsychology 1 week later: Decreased immediate attention, slowed processing of information, reduced verbal reasoning ability and visuo-constructional skills.

Case prepared by Dr. Sandra Petty and Dr. Peter Mitchell, Neurosciences, Royal Melbourne Hospital.

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