A 41-year-old male patient presented with altered mental status and generalized seizures after completion of a protocol combining radiation therapy and cisplatin for a recently diagnosed poorly differentiated nasopharynx squamous cell carcinoma (SCC) with basaloid features. A brain MRI showed abnormal enhancement of the temporal lobes bilaterally in the T2/flair sequence (Panel A) and after gadolinium administration, there was intense gyral enhancement in the same topography (Panel B arrows). A CSF examination demonstrated positive HSV serologies for IgG and IGM and increased protein levels. The patient received high-dose parenteral acyclovir for 21 days with clinical improvement and was discharged from the hospital with anti-seizure medications and with residual behavioral changes (aggressiveness).