Fig 2. Neuroimaging findings in severe TBE.

(A and B), A 23-year-old male patient with severe ME and extensive panencephalitis but complete recovery after 12 months. MRI at admission showed T2-weighted axial lesions of the left semioval centre (A, arrowhead), right inferior colliculum tecti (B, upper panel) and right medulla oblongata (B, lower panel) Not shown: additional T2-weighted lesions in the thalamus and cerebellar peduncles. (C and D), A 62-year-old male MER patient initially misdiagnosed as lacunar stroke with consciousness disturbance, complete hemiplegia, dysphagia and lethal course due to aspiration pneumonia: axial fluid-attenuated inversion recovery (FLAIR) sequence depicts a rounded hyperintense lesion in the left thalamus (arrowhead) (C) that shows pathological water diffusion on diffusion-weighted imaging (DWI) (D, upper panel). Corresponding ADC map identifies the lesion as vasogenic oedema with enhanced water diffusion (D, lower panel), incompatible with acute or subacute stroke. (E and F), A 49-year-old female MER patient with “man in the barrel syndrome” (unable to move her upper limbs) as long-term outcome. MRI at admission showed extended encephalitis, cervical myelitis and brachial radiculitis: axial FLAIR image depicts bilateral hyperintense lesions of caudate nucleus (arrowheads), cingulate cortex (red arrows), and left external capsule (black arrow) (E). A T1-weighted, fat-saturated coronal image of the brachial plexus shows bilateral contrast enhancement of the displayed nerve roots and fascicles, proving radiculitis (F). Inset: A T2-weighted axial image of the cervical myelon shows bilateral, symmetrical, hyperintense lesions strictly confined to the anterior horn.