Dr. James Abraham responds:

Encephalitis is a broad term that basically refers to inflammatory disease of the brain. There are many agents that can cause this.
Encephalitis from Herpes, for example, may look quite
different from that caused by bacteria or fungus. So the answer is yes, encephalitis can potentially present as small areas of enhancement. I
am not sure what you mean by 'micro insults', but if you are referring to areas of ischemia, such as lacuna infarcts, then the two could possibly look the same. They should be distinguishable by noting differences in clinical presentation. Ischemia is acute, while infection is less acute and presents with other signs. Radiographically both can enhance, but the time for onset of enhancement may be different and the encephalitis will get worse while the infarct
will usually remain static.