Clinical Reasoning: An 11-year-old girl with focal seizures, fevers, and unilateral, enhancing cortical lesions.

An 11-year-old girl with no relevant medical history experienced acute-onset confusion and speech arrest without loss of consciousness, eye deviation, tonic stiffening, or convulsion. At an outside emergency department, her examination included expressive aphasia, right lower facial droop, and right-sided hemiparesis. Noncontrast head CT was negative for acute intracranial pathology, CT angiogram showed patent vasculature, and CT perfusion showed no areas of perfusion mismatch. The patient was transferred to our institution for further management.