Embolic Shower Pattern on Magnetic Resonance Imaging: An Atypical Presentation of Chikungunya Encephalitis

Chikungunya virus (CHIKV) infection, typically associated with fever, rash, and polyarthritis, can rarely involve the central nervous system (CNS). Neuroinvasive chikungunya presenting as encephalitis has been reported sporadically, with imaging findings yet to be comprehensively documented. We report a unique case of chikungunya encephalitis in a 64-year-old male presenting with altered sensorium and neurological deficits following a febrile illness. Magnetic resonance imaging (MRI) of the brain revealed multiple foci of diffusion restriction scattered across the cerebral and cerebellar hemispheres, mimicking an embolic shower pattern, without significant contrast enhancement or hemorrhage. No evidence of vascular occlusion or endocarditis was found. The absence of other infectious or embolic sources, along with positive chikungunya serology, confirmed chikungunya encephalitis. This case highlights an unusual neuroimaging manifestation of CHIKV encephalitis, highlighting the need for clinicians and radiologists to recognize such atypical imaging features to aid in early diagnosis and management, particularly in endemic regions.