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Japanese encephalitis

Case contributed by Ankit Chauhan
Diagnosis almost certain

Presentation

Fever for 4-5 days. Altered sensorium and vomiting.

Patient Data

Age: 20 years
Gender: Female
mri

Hyperintense signal on T2 and FLAIR images involving bilateral thalami, caudate nuclei, pons, midbrain, left occipital lobe and bilateral cerebellar hemispheres. Patchy focal areas of blooming are seen within the thalami and pons, suggestive of hemorrhage. Basilar artery flow void is maintained on T2 images. Venography showed no thrombosis of the internal cerebral vein or straight sinus.

Case Discussion

Japanese encephalitis still remains a major health problem in India and Southeast Asia. Clinical history with typical MRI features showing bilateral thalamic involvement are pivotal in diagnosis. 

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