The imaging provided is an axial T2-FLAIR MRI showing hyperintensities of the bilateral temporal lobes (right greater than left). Herpes simplex encephalitis predominantly affects the medial temporal lobes. Lesions will often have surrounding edema, restricted diffusion, and contrast enhancement. The lesions do not have a single vascular territory involved, making ischemic stroke unlikely. A sagittal sinus thrombosis can cause subcortical hyperintensities on T2 imaging and intraparenchymal bleeding. Cerebral toxoplasmosis lesions often have a circle/ring of enhancement on contrast studies.