A 16-year-old boy presented with a fever and decreased responsiveness for one day. There was no history of focal neurological deficits or seizures. On examination, he was hemodynamically stable but drowsy. Meningeal signs and bilateral extensor plantar responses were present. Contrast-enhanced magnetic resonance imaging (CEMRI) of the brain demonstrated asymmetric (left > right) hyperintensities on T2-weighted and fluid-attenuated inversion recovery (T2/FLAIR) sequences involving the bilateral temporal lobes, basifrontal cortex, cingulate gyri, and insular cortex, with sharp demarcation from the basal ganglia.
