Question

A male patient presented to the emergency room with seizures. He has a history of fever, headache, and confusion. An MRI brain was done, and it showed inflammation involving the bitemporal lobe. What is the most likely aetiology for this presentation?

• A. Cytomegalovirus
• B. Toxoplasma gondii
• C. Herpes simplex virus
• D. Mycobacterium tuberculosis

Answer 1

The Correct Option is C

The clinical presentation described in the question involves a male patient with seizures, fever, headache, confusion, and MRI indications of bitemporal lobe inflammation. To determine the most likely aetiology, we need to consider common causes of encephalitis with these specific symptoms:

• Herpes Simplex Virus (HSV): The most common cause of encephalitis presenting with acute onset of fever, seizures, altered mental status, and focal neurological deficits. The classic MRI finding is inflammation in the temporal lobes, specifically the bitemporal region. HSV encephalitis is often the first consideration in such a presentation.
• Cytomegalovirus (CMV): Generally occurs in immunocompromised individuals, leading to a more diffuse encephalitis not typically limited to the temporal lobes.
• Toxoplasma gondii: Typically causes multiple ring-enhancing lesions in the brain, more common in immunocompromised patients, such as those with AIDS.
• Mycobacterium tuberculosis (TB): Can cause chronic meningitis or tuberculomas, identifiable with different MRI patterns, usually not limited to bitemporal regions.

Based on the described symptoms and MRI findings, Herpes Simplex Virus (HSV) is the most consistent cause. HSV targets the temporal lobes and is known for causing focal neurological symptoms alongside systemic features.