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Hence there was a large possibility of combined intracranial infection. was diagnosed with JE. During treatment, her condition became aggravated and the brain computed tomography (CT) scan showed multiple lobar hemorrhages. One month later, the multiple lobar hemorrhages occurred again, as observed by a brain CT scan. Diagnosis: JE with multiple intracranial hemorrhages. Interventions: The patient was treated comprehensively, including surgery, lowering her intracranial pressure and ventilator-assisted Tivozanib (AV-951) breathing. Outcomes: One month later, the patient underwent another surgical procedure for intracranial hemorrhage and suffered a serious neurological disorder. Lessons: Severe intracranial hemorrhage may occur in elderly patients with JE, especially in those with poor vascular condition. Therefore, when treating such patients, great caution, as well as early detection and prevention, should be taken in case of the occurrence of severe intracranial hemorrhage. in China. Therefore, JE usually occurs in summer and autumn, especially in the months between July and September, which accounts for more than 90% of cases in the entire year.[5] The sudden onset, severe illness, and rapid development of JE seriously harms the health and life of the patients who contract it. Craniocerebral MRI and CSF examination are of great significance for early diagnosis. The manifestations usually observed in head MRIs of JE patients are low T1WI signal, high T2WI signal and high DWI signal in the thalamus, basal ganglia, substantia nigra, cerebellum, pontine, cerebral cortex, and spinal cord, as well as other parts of the cerebral cortex and spinal cord.[6] Lesions in the bilateral NCR3 thalamus are highly suggestive of JE; however, basilar artery syndrome and primary central Tivozanib (AV-951) nervous system lymphoma also need to be excluded. There can be elevated protein and leukocyte levels in the CSF of JE patients, while the sugar and chloride levels are normal. JEV IgM appears 4 to 7 days after infection and peaks after 2 weeks. The sensitivity and specificity of the IgM antibody captured in enzyme-linked immunosorbent assays are both over 95%, and diagnosis can be confirmed using a single CSF or serum sample.[7] In this case, the patient had light hemiplegia combined with gastrointestinal reaction at the early onset of the disease. Therefore, cerebral infarction caused by insufficient vascular capacity due to stenosis was initially considered; however, the patient’s head MRI suggested frontal lobe lesions associated with right central facial palsy, and the cerebral infarction lesion could not fully explain the symptoms and signs of the patient. Hence there was a large possibility of combined intracranial infection. Considering her high fever, a differential diagnosis needed to be made among JE, toxic dysentery, enterovirus meningitis, listerial encephalitis, and herpes simplex encephalitis. The patient had no signs of septic shock and a normal stool routine, which could exclude toxic dysentery. Enterovirus meningitis patients generally recover quickly, and the symptoms can be relieved in 2 to 3 3 weeks, but the patient’s condition continued to worsen. Additionally, her blood and CSF culture for Listeria were negative. In regards to herpes simplex virus encephalitis, the patient had no temporal lobe lesions observed by head Tivozanib (AV-951) MRI and was negative for CSF antibodies, so there Tivozanib (AV-951) was no evidence to diagnose herpes simplex encephalitis. Hashimoto encephalopathy and autoimmune encephalitis can also cause a similar clinical picture, but thyroid peroxidase antibody and autoimmune encephalitis-related Tivozanib (AV-951) antibodies were negative in our patient. Therefore, due to the results of the MRI imaging and a positive test for JE-specific IgM antibody in CSF and blood, the patient was diagnosed with JE. A review of the literature suggested that JE complicated with intracerebral hemorrhage can manifest as bilateral thalamic and basal ganglia hemorrhage, which is related to vascular injury caused by inflammation and combined intracranial venous sinus thrombosis.[8,9] However, there has been no previous report of JE with multiple lobar hemorrhages. In this case, although mono-antibody treatment was used for only 9 days, the.