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CASE 7: Description of Imaging Findings
MRI of the brain without and with contrast. Select images are shown.
Questions
1. Where is the abnormality located?
2. Describe the abnormality using appropriate terminology.
3. What is the differential diagnosis for this abnormality?
- Infection: The location of this abnormality is characteristic of herpes encephalitis. HSV has a predilection for the temporal lobes and insula. Hemorrhage can also be seen. Given that this patient is presenting with fevers, HSV is the favored diagnosis.
- Stroke: Infarction should also be considered; however, given that this abnormality spans 2 vascular territories (lateral temporal lobe supplied by the MCA and the medial lobe supplied by the PCA), this is felt to be less likely. The clinical presentation also does not support this diagnosis.
- Tumor: There are certain types of low grade Astrocytomas that can present with similar imaging features. Given that this patient is presenting with infectious symptoms, tumor is considered less likely.
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