Clinical question: 28 day old male HSV in CSF. Drain involvement? Signs and symptoms: HSV in CSF. Non-enhanced CT of brain:There are small foci of increased density along the medial aspect of right anterior temporal tip. The larger of these findings measures approximate the 4-mm times 4-mm on coronal reformatted image 17 an approximately 5 mm in transverse axis on axial post infusion imaging 8. The smaller lesions measure approximately 3 mm on axial image 7. I cannot be certain whether these represent subtle enhancement which which could represent a meningeal enhancement or may represent minimal parenchymal hemorrhage. In either case considering patient's clinical history a follow-up exam with an MRI is recommended. There is paucity of cortical sulci and the ventricular system remains small the patient's stated age of 27 days although no definitive edema is detected the findings may represent subtle underlying diffuse parenchymal edema. There is no evidence of midline shift. Images through posterior fossa are essentially unremarkable.Above findings were discussed at the time of interpretation with Dr.Gui.
Small foci of increased density in the right anterior temporal lobe which may represent minimal enhancement or small amount of parenchymal hemorrhage. Paucity of cortical sulci and the small lateral ventricles may also represent subtle underlying parenchymal edema. Further follow-up with a dedicated MRI examination is recommended.