A 35-year-old female presented with fever for 3 days, altered mental status for 2 days, and seizures for 1 day. MRI showed hypo-intense lesions in the thalamus on T1 imaging and hyper-intense lesions in the thalamus, caudate nucleus, and lentiform nucleus on T2 imaging. Differential diagnoses included various infections, tumors, and other conditions. Japanese encephalitis was considered highly likely given bilateral thalamic hyperintensities on MRI and confirmation via CSF serology testing.