Findings:
There are low-lying cerebellar tonsils projecting approximately 3 mm below the foramen magnum. There is a small-appear posterior fossa with partial effacement of the basal cisterns, which likely represents an anatomic variation.
Administration of contrast demonstrates enhancement within several parietal-occipital sulci bilaterally which may reflect leptomeningeal enhancement. The bilateral transverse sinuses may narrow slightly at the distal aspects.

Impression:
There is no intracranial mass lesion or sign of impending herniation to contraindicate a lumbar puncture. However, there is leptomeningeal enhancement which may represent meningitis or meningeal carcinomatosis. In this clinical presentation, it is consistent with meningitis. 

Recommendations:
For your training purposes, recommendations are not included in this report.