Bilateral medial temporal lesions in Japanese encephalitis
Citation Manager Formats
Make Comment
See Comments

A 62-year-old woman presented with headache, fever, and deteriorating consciousness. Brain MRI showed bilateral lesions of the thalamus and substantia nigra. The medial temporal region was also involved bilaterally (figure). The serum hemagglutination inhibition test for Japanese encephalitis (JE) virus was initially negative; the titer was increased to 1:640 10 days later. Therefore, a diagnosis of JE was made. The patient remained in a vegetative state for 2 months before dying of pneumonia. Medial temporal lesions are seen in herpes simplex encephalitis, paraneoplastic limbic encephalitis, and neurosyphilis.1 JE also commonly produces medial temporal lesions.2 However, medial temporal lesions associated with bilateral thalamic or midbrain involvement may be more suggestive of JE, particularly in endemic areas.
Figure. Fluid-attenuated inversion recovery axial MRI without contrast enhancement shows high-signal lesions in both thalami (A) and bilateral lesions of the medial temporal region and substantia nigra (B). Noncontrast brain CT taken at 4 weeks after initial MRI reveals low attenuation in both thalami (arrowheads) (C) and in both medial temporal regions (arrows) (D). Mild increase of ventricle size is also noted.
1.
2.
Footnotes
-
Disclosure: The authors report no conflicts of interest.
Disputes & Debates: Rapid online correspondence
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Related Articles
- No related articles found.