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Temporal Lobe Lesions
An 80-year-old woman with headache and speech changes. ADC , apparent diffusion coefficient; Ax , axial; CT, computed tomography; DWI , diffusion-weighted imaging; FLAIR , fluid attenuated inversion recovery.
A 59-year-old man with hypertension and poor medical compliance was found down and unable to speak, presenting with dense right hemiplegia. ADC , apparent diffusion coefficient; Ax , axial; DWI , diffusion-weighted imaging; FLAIR , fluid attenuated inversion recovery; MTT, mean transit time.
A 28-year-old woman with hallucinations and amnesia. ADC , apparent diffusion coefficient; Ax , axial; DWI , diffusion-weighted imaging; FLAIR , fluid attenuated inversion recovery.
A 53-year-old woman with expressive aphasia. ADC, apparent diffusion coefficient; Ax , axial; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery; GRE, gradient refocused echo.
DESCRIPTION OF FINDINGS
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Case A: There are temporal FLAIR abnormalities (greater on the left than the right) with mild mass effect. There is mild hyperintensity on DWI due to T2 effects and hyperintensity, consistent with elevated diffusion, on the ADC maps. Corresponding hypodensity is seen on noncontrast head CT.
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Case B: A left temporal and inferior frontal FLAIR abnormality with mild mass effect in the middle cerebral artery (MCA) vascular territory without associated enhancement is seen. Restricted diffusion is present with DWI hyperintensity and ADC hypointensity. MR perfusion imaging demonstrates prolonged mean transit time in the abnormal left temporal lobe. Not shown is involvement of a significant portion of the MCA territory, including the perirolandic region.
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Case C: There are left larger than right medial temporal lobe FLAIR hyperintense lesions. The lesions do not enhance and have normal diffusion.
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Case D: Bilateral temporal and right inferior frontal FLAIR hyperintense lesions have mild mass effect and normal to elevated diffusion. The left anterior temporal lobe has a T1 hyperintense focus demonstrates blooming, consistent with hemorrhage, on the gradient echo susceptibility sequence. In the right posterior mesial temporal lobe there is a small focus of enhancement. On subsequent imaging several months later, there was marked progression of enhancement to involve both temporal lobes.
Diagnosis
Case A
Herpes simplex virus (HSV) encephalitis confirmed by CSF polymerase chain reaction
Case B
Temporal lobe infarct
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