{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T02:49:54Z","timestamp":1761274194649,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Johannes Kepler University Open Access Publishing"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>(1) Background: To report two cases of severe tick-borne encephalitis (TBE) in elderly patients presenting with a previously undescribed subarachnoid T2\/FLAIR hyperintensity on repeated MRI examinations, which may serve as an early imaging biomarker of disease severity. (2) Methods: Two unvaccinated 82-year-old patients (one male and one female) presented with acute encephalitis and required intensive care. Serial brain MRI, EEG, CSF analysis, and neurophysiological assessments were performed. (3) Results: Both patients showed rapid progressive neurological deterioration in the context of TBE, confirmed by elevated serum and CSF IgM and IgG titers. Early follow-up MRI revealed striking sulcal hyperintensities on T2\/FLAIR sequences, interpreted as protein-rich subarachnoid inflammatory changes. These changes paralleled clinical worsening and resolved on follow-up imaging. The male patient developed meningoencephalomyeloradiculitis, remained comatose, and died from respiratory failure (the brain and spinal cord were examined postmortem). The female patient had meningoencephaloradiculitis with severe dysphagia and was discharged with a modified Rankin Scale score of four. Both patients demonstrated epileptiform EEG activity. The CSF analysis revealed markedly elevated total protein, lactate, tau protein, and CXCL13, as evidence of blood\u2013brain barrier disruption and inflammatory neurodegeneration. (4) Conclusions: We describe acute subarachnoid T2\/FLAIR hyperintensity in TBE as an imaging feature that may correlate with severe systemic inflammation and a poor prognosis. This radiological finding could serve as a potential early prognostic marker in TBE.<\/jats:p>","DOI":"10.3390\/life15111655","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T09:44:30Z","timestamp":1761212670000},"page":"1655","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Sulcal FLAIR Hyperintensity in Severe Tick-Borne Encephalitis: A Potential Prognostic Marker"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3113-9497","authenticated-orcid":false,"given":"Vincent","family":"B\u00f6hm","sequence":"first","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan-Andrei","family":"Ianosi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Helios Klinikum Emil von Behring, 14165 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Kulyk","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz","family":"Gruber","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Mitterling","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amadeus","family":"Hauser","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Eger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"K\u00f6hl","sequence":"additional","affiliation":[{"name":"Division of Neuropathology, Neuromed Campus, Department of Pathology and Molecular Pathology, Kepler University Hospital, Johannes Kepler University Linz, 4021 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6750-2599","authenticated-orcid":false,"given":"Serge","family":"Weis","sequence":"additional","affiliation":[{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Division of Neuropathology, Neuromed Campus, Department of Pathology and Molecular Pathology, Kepler University Hospital, Johannes Kepler University Linz, 4021 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sibylle","family":"Wimmer","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, 4021 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Sonnberger","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, 4021 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raimund","family":"Helbok","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johannes Kepler University Linz, 4020 Linz, Austria"},{"name":"Clinical Research Institute for Neurosciences, Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Worku, D.A. 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