Eastern equine encephalitis: MRI findings in two patients.

Volume 95 No. 7 July 2012 a previously healthy 20 year-old male presented to the Rhode Island Hospital Emergency Department with 24 hours of worsening abdominal pain, vomiting, and fevers. On physical examination he appeared diaphoretic and febrile, with an oral temperature of 104.3°. The patient was noted to have tenderness to palpation in the epigastric region. Initial laboratory evaluation revealed a white blood cell count of 23,000/μl. A CT scan of the abdomen and pelvis was normal, with no evidence of appendicitis as was suspected clinically. The patient was started empirically on IV antibiotics and admitted for observation. On the first night of admission, the patient developed a severe headache, with subsequent rapid deterioration of his mental status. Status epilepticus soon followed. He was intubated for airway protection and transferred to the Medical Intensive Care Unit. A non-contrast CT scan of the head showed diffuse cerebral edema and effacement of the basilar cisterns. Brain MRI performed shortly thereafter revealed abnormal T2 and FLAIR signal hyperintensity involving the bilateral thalami in a symmetric manner, as well as the left external capsule and tegmentum pons (Figures 1, 2, and 3; white arrows). Prominent perivascular congestion was also noted (Figure 4; white arrows).  Matthew Ethier, MD, and Jeffrey Rogg, MD Images In Medicine eastern equine encephalitis: mRi Findings in two Patients