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Fig. 18B. —18-year-old woman with Rift Valley fever. Patient with visual symptoms and encephalitis was confirmed to have positive serology findings for acute Rift Valley fever infection during recent outbreak in Saudi Arabia. Initial CT of brain had normal findings (not shown). Neurologic symptoms of lethargy, confusion, and paralysis persisted. Repeated CT scans without (A) and with (B) IV contrast material. Both images show multiple areas of low attenuation in cerebral cortex, most prominently in occipital lobes (arrows). Although similar appearance can be caused by microvascular damage to occipital white matter as a result of hypertensive encephalopathy, patient had no history of hypertension.