Case 3

This is an MRI brain study showing bilaterally enlarged thalami which exhibit T2 and FLAIR signal hyperintensity. There is also patchy high T2 and FLAIR signal intensity in the corona radiata and subcortical white matter of the frontal and parietal lobes; these findings indicate oedema and cytotoxic damage.

I note that there is no post contrast enhancement in the thalami or involved areas of the brain parenchyma; there is no evidence of haemorrhage on the SWI images. There is no restricted diffusion on the DWI series. There is no evidence of deep cerebral venous thrombosis on the MRV images to suggest venous infarction.

The findings are most in keeping with viral encephalitis (such as Japanese encephalitis); the differential diagnosis includes ADEM (acute disseminating encephalo-myelitis).

Leigh’s syndrome and bilateral thalamic glioma are other considerations.

I would contact the referring physician and convey the findings. I would also flag this case for discussion at neurology MDT.