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MRI: Bilateral Thalamic Hyperintensities

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MRI: Bilateral Thalamic Hyperintensities

  1. 1. IMAGE OF THE WEEK
  2. 2. <ul><li>35 yr old female admitted with complaints of </li></ul><ul><li>fever for past 3 days </li></ul><ul><li>altered sensorium for past 2 days </li></ul><ul><li>convulsions for past 1 day </li></ul><ul><li>PAST HISTORY: </li></ul><ul><li>not a known DM/HT/EPILEPTIC/BA </li></ul><ul><li>PERSONAL HISTORY: </li></ul><ul><li>not a smoker/alcoholic </li></ul><ul><li>mixed diet </li></ul><ul><li>CONTACT HISTORY: </li></ul><ul><li>no contact with TB </li></ul>
  3. 3. <ul><li>central nervous system: </li></ul><ul><li>higher functions; </li></ul><ul><li>E2 V2M5 </li></ul><ul><li>pupils reacting equally ; </li></ul><ul><li>ocr + </li></ul><ul><li>motor system; moves all four limbs </li></ul><ul><li>sensory system; couldn’t examined. </li></ul><ul><li>cranial nerves; no cranial nerve involment </li></ul><ul><li>terminal neck stiffness +; </li></ul><ul><li>spine & cranium; normal </li></ul><ul><li>Other systems: normal. </li></ul>
  4. 8. <ul><li>T 1 shows - hypo intense lesion in thalamus. </li></ul><ul><li>T 2 shows- hyperintense lesion in thalamus,caudate </li></ul><ul><li>nucleus and lentiform nucleus . </li></ul><ul><li>Fl uid A ttenuated I nversion R ecovery - lesions not </li></ul><ul><li>suppressed . </li></ul>
  5. 9. <ul><li>Bilateral thalamic glioma </li></ul><ul><li>Wernicke s encephalopathy </li></ul><ul><li>Osmotic myelinosis </li></ul><ul><li>Wilson s disease </li></ul><ul><li>Infections – west nile, japanese encephalitis,rabies eastern equine, murray valley </li></ul><ul><li>Vascular occlusion- venous thrombosis,pregnancy,ocp, dehydration, trauma </li></ul><ul><li>Fabry’s, fahr’s disease. </li></ul>
  6. 10. <ul><li>In the background of Acute CNS Infection  </li></ul><ul><li>MRI showing b/l thalamic hyperintensities  </li></ul><ul><li>Japanese Encephalitis, a strong possibility. </li></ul><ul><li>The CSF serology confirmed it. </li></ul>
  7. 11. HSV ENCEPHALITIS T 2 & FLAIR – hyperintensities in fronto orbital and temporal cingulate and insular region ; WEST NILE ENCEPHALITIS, JE , RABIES , T2 & FLAIR – hyperintensities in thalamus basal ganglia & brainstem ; VZV ENCEPHALITIS Multifocal areas of hemorrhagic and ischemic infarcts (or) hyperintensities in basal ganglia CMV ENCEPHALITIS T2 hyperintensities in periventricular areas and enlarged ventricles PML T2 & FLAIR -multifocal asymmetric periventricular hyperintense lesion in parietooccipital region and cerebellum
  8. 12. <ul><li>Thank </li></ul><ul><li>You </li></ul>

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