Herpes simplex virus encephalitis
4 day history of fever and confusion. No other focal neurology on examination.
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There is cortical and subcortical FLAIR hyperintensity involving the medial aspect of the left temporal lobe, the left insula and the anterior aspect of the left temporal lobe. There is associated mild increased signal on diffusion weighted imaging.
Partially-imaged mucosal thickening of the left maxillary antrum.
The patient was initially treated with broad spectrum antivirals and antibiotics. CSF and blood samples confirmed herpes simplex 1 DNA. The patient was treated for 21 days with acyclovir. During admission the patient suffered from fluctuating delirium and never completely recovered to his baseline. He was eventually discharged to a nursing home for ongoing care.