A 47-year-old man with HSE

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High-signal-intensity lesions on T2-weighted MR images

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Presentation transcript:

A 47-year-old man with HSE A 47-year-old man with HSE. A, Bilateral symmetric cortical swelling and hyperintensity on axial FLAIR were observed in the anteromedial TLs (arrows) and also affected the insular cortex and rectus gyri (arrowhead). A 47-year-old man with HSE. A, Bilateral symmetric cortical swelling and hyperintensity on axial FLAIR were observed in the anteromedial TLs (arrows) and also affected the insular cortex and rectus gyri (arrowhead). B, Restricted diffusion was documented in the same areas on DWI (asterisks). Bilateral and usually asymmetric involvement of the limbic system sparing the basal ganglia in the setting of acute LE should raise concerns for HSE. The presence of hemorrhagic foci and gyriform enhancement are also of diagnostic value in more-advanced disease. C, A similar pattern with bilateral asymmetrical involvement of the anteromedial TLs (arrows) on coronal FLAIR was observed in addition to the extensive white matter changes (arrowheads) in a 59-year-old man with progressive dementia who was later diagnosed with neurosyphilis. A.J. da Rocha et al. AJNR Am J Neuroradiol 2015;36:2196-2205 ©2015 by American Society of Neuroradiology