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Chapter 43

Nervous System Complications of Systemic Viral Infections

John E. Greenlee

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Figure 43-1 A, Magnetic resonance imaging (MRI) of herpes simplex virus encephalitis. T2-weighted fluid-attenuated inversion recovery (FLAIR) sequence showing increased signal in right temporal lobe, insula, and orbitofrontal cortex. There is also involvement of the left insula. B, T1-weighted MRI 6 months after infection, showing massive destruction of the left temporal lobe.

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Figure 43-2 Distribution of West Nile virus in the United States showing cases of infection and WNV identified in blood donors, 2012.(From the US Centers for Disease Control and Prevention.)

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Figure 43-3 Distribution of cases of West Nile neuroinvasive disease in the United States, 2012.(From the US Centers for Disease Control and Prevention.)

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Figure 43-4 Progressive multifocal leukoencephalopathy (PML): axial T2-weighted MRI showing multifocal involvement of cerebral white matter.

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Figure 43-5 FLAIR MRI showing PML with immune reconstitution inflammatory syndrome (IRIS) in a patient with human immunodeficiency virus (HIV) following institution of antiretroviral therapy. There is edema in and surrounding a lesion within the left posterior cerebral white matter.

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Figure 43-6 Creutzfeld–Jakob disease. Diffusion-weighted MRI image showing restricted diffusion within the cortical ribbon of the posterior hemispheres bilaterally.

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Figure 43-7 Acute disseminated encephalomyelitis. T2-weighted MRI showing multifocal areas of increased signal in the white matter.(From Wender M: Acute disseminated encephalomyelitis (ADEM). J Neuroimmunol 231:92, 2011, with permission from Elsevier.)