Findings :
Bilateral asymmetrical hypodense area in the temporal region with hyperdense focus.

Diagnosis:
Herpes encephalitis.

Discussion:
HSE is most common viral encephalitis in children & adults.  HSE as a particular predilection for limbic system that is  Temporal lobes, Insular cortex, sub frontal area & the cingulate gyri. involvement may initially appear unilateral but is typically followed by less severe contra lateral disease. This "sequential bilaterality" is highly suggestive of HSE1.
Patient typically present with altered mental status. Seizures, fever and head aches are also common. Early diagnosis & prompt therapy are essential as disease progress rapidly. Mortality rate with HSE between 50% to 70%

Reference :Diagnostic neuroradiology by ANNE G. OSBORN.

Submitted by :PROF. DR.V. RAMATARAK NATH