Paralytic Rabies Encephalomeningomyelitis: A Tale of Two Cases With Emphasis on Imaging Findings and Relevant...

Imaging documentation of rabies encephalitis remains rare because of the progressive and fatal course of the disease. We present two cases of paralytic rabies encephalomeningomyelitis, showing varied imaging findings, one in a two-year-old girl whose magnetic resonance imaging (MRI) illustrated typical features, and another case of a 65-year-old female with atypical MRI findings. These two cases emphasize that classical rabies shows predominant grey-matter involvement, whereas an atypical presentation, particularly in elderly patients with underlying comorbidities, shows a predilection for white matter, in contrast to the typical form. The identification of this varied imaging spectrum is crucial for prompt diagnosis, especially in endemic zones. The rarity of antemortem neuroimaging in rabies, with detailed documentation of typical and atypical cases, enriches the limited diagnostic literature and improves early recognition of the disease's imaging spectrum.