Question:
A 25 year old person presents with acute onset of fever and focal seizures. MRI scan shows hyperintensity in the temporal lobe and frontal lobe with enhancement. The most likely diagnosis is:
A 25 year old person presents with acute onset of fever and focal seizures. MRI scan shows hyperintensity in the temporal lobe and frontal lobe with enhancement. The most likely diagnosis is:
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Temporal lobe hyperintensity with fever and seizures equals HSV.
Updated On: Jun 24, 2026
- Meningococcal meningitis
- Herpes simplex encephalitis
- Japanese encephalitis
- Tuberculous meningitis
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Verified By Collegedunia
The Correct Option is B
Solution and Explanation
Step 1: Note the clinical picture. Acute fever plus focal seizures points to encephalitis (brain parenchyma involvement) rather than meningitis (meningeal involvement), because focal deficits and seizures indicate the brain substance is inflamed.
Step 2: Use the MRI localisation. The hallmark of Herpes Simplex Virus (HSV) encephalitis is involvement of the medial temporal lobes and the inferior frontal (orbitofrontal) regions, often with edema, hemorrhage and gadolinium enhancement. The stem describes exactly this temporal plus frontal lobe hyperintensity with enhancement.
Step 3: Confirm why HSV fits. HSV-1 has a tropism for the limbic system. It is the commonest cause of sporadic fatal viral encephalitis and is a medical emergency that needs early intravenous acyclovir. Temporal lobe involvement is the classic clue.
Step 4: Exclude the distractors. Meningococcal meningitis causes meningeal signs and a rapidly spreading purpuric rash, not focal temporal lobe MRI changes. Japanese encephalitis classically affects the thalamus and basal ganglia, not the temporal lobes. Tuberculous meningitis causes basal meningeal enhancement and hydrocephalus, not focal temporal lobe hyperintensity.
Conclusion: Temporal and frontal lobe involvement with seizures is Herpes simplex encephalitis, option B.
Step 2: Use the MRI localisation. The hallmark of Herpes Simplex Virus (HSV) encephalitis is involvement of the medial temporal lobes and the inferior frontal (orbitofrontal) regions, often with edema, hemorrhage and gadolinium enhancement. The stem describes exactly this temporal plus frontal lobe hyperintensity with enhancement.
Step 3: Confirm why HSV fits. HSV-1 has a tropism for the limbic system. It is the commonest cause of sporadic fatal viral encephalitis and is a medical emergency that needs early intravenous acyclovir. Temporal lobe involvement is the classic clue.
Step 4: Exclude the distractors. Meningococcal meningitis causes meningeal signs and a rapidly spreading purpuric rash, not focal temporal lobe MRI changes. Japanese encephalitis classically affects the thalamus and basal ganglia, not the temporal lobes. Tuberculous meningitis causes basal meningeal enhancement and hydrocephalus, not focal temporal lobe hyperintensity.
Conclusion: Temporal and frontal lobe involvement with seizures is Herpes simplex encephalitis, option B.
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