Question Title: Encephalitis or Migraine?

I am a 53 yo female with no history of migraine and seldom have headaches
of any kind. Healthy. Active.

I had an MRI on Nov. 4 to eliminate or confirm a mini-stroke that took
place 3 weeks earlier. Symptoms: aura, speech difficulty, headache, feeling
"unbalanced" but not dizzy.)

The report results:
The ventricles, basilar cisterns and cortical suici
are within normal limits of size for age. There is no evidence of intracranial
hemorrhage, midline shift or other mass effect.

There is extensive hyperintensity on the long TR and FLAIR sequences and
swelling involving the left temporal lobe extensively, including the
hippocampus and amygdala, the left occipital lobe, the left anterior parietal
lobe, the left parieto-occipital junction and the right hippocampus.

There are no foci of abnormal enhancement.

Gradient echo images demonstrate no evidence of abnormal intra-axial magnetic
susceptability.

There are flow voids (indicating patency) within the basilar, interal carotid
and cisternal vertebral arteries.

IMPRESSION: 1. Multiple cortical signal abnormalities with associated
swelling, including involvement of both mesial temporal lobes and the left
insule. These findings are characteristic of herrpes encephalitis. 2. Otherwise
unremarkable MRI of the brain.
(End of report)

A spinal tap showed clear fluid. I was told that nothing important showed up
in the lab work. The radiologist suggested that I be placed on an anti-viral
treatment regardless of the lab results based on the MRI. However, the
neurologist prescribed an antidepressent for my "migraine" and sent me
home with instructions to repeat the MRI in 4 weeks.

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This MRI scan report is very unusual as it is totally out of synch with your
clinical state and your CSF findings. Encephalitis is a very severe illness
which should leave you in a comatose state with high fever and very severe
speech and memory problems, you would not be able to create this message
if you had bilateral temporal lobe herpes encephalitis !!!
The CSF would also be dramatically abnormal with a raised white cell count
if you had herpes encephalitis.
Having said all of this I cannot, without seeing the scan say what actually
caused the changes seen on the MRI, it certainly seems like a good idea to
repeat the scan in a few weeks to see if this process has settled down,
however I appreciate your concern in the meantime.
You should perhaps have the scans reviewed by another neurologist and
ask if sterile causes of inflammation (auto-immunity )in the temporal
lobes ( limbic encephalitis )have been outruled.

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