Brain Infection - T2-w turbo spin-echo
Brain Infection - T2-w turbo spin-echo
Search Pattern Assist ?Exam
Purpose
1. There is active, inflammatory phase (> 3 days duration) secondary leptomeningitis.
2. The secondary leptomeningitis spread from the ethmoid sinusitis to the CNS via phlebothrombosis or thrombophlebitis affecting the intraparenchymal penetrating and possibly cortical veins in multiple areas of the cerebrum bilaterally. Whether there is only paravenous inflammation or is in part actual cerebritis is indeterminate; correlate with DWI.
MR T1-w post contrast
1. The extent of the mucosal intrasinus ethmoid edema is consistent with active sinusitis. It likely has spread to the right preseptal soft tissues, and to the meninges via a venous route. This includes the right orbital veins and both cerebral cortical and penetrating veins. This accounts for the multicentric linear areas of intracerebral contrast enhancement (i.e. infectious, venous, vasculitis). It remains indeterminate as to whether there is actual parenchymal cerebritis.
2. There is minimal early hydrocephalus, which is not uncommon in leptomeningitis in the inflammatory phase.
MR diffusion
1. Bifrontal subdural effusions are present without MR diffusion water restriction to confirm organized empyema.
2. There are three small sites of likely post ischemic injury, as above.
3. There is no positive MR diffusion to confirm cerebritis surrounding any of the multiple sites of enhancing perivascular spaces. These sites likely enhance on the basis of venous thrombosis or thrombophlebitis.
MR susceptibility (SWI)
1. There is diffuse venous hyperemia. There is no confirmation of absent major deep or pial veins to confirm actual thrombosis. The MR flair and MR T1 contrast enhancement is likely the result of mural inflammation of patent veins.
Findings
MR T2-w turbo spin-echo
There is evidence of leptomeningitis. [Yes/No]
There is evidence of primary pachymeningitis. [Yes/No]
There is evidence of secondary pachymeningitis from extracranial infection site. [Yes/No]
There is evidence of cerebritis. [Yes/No]
There is evidence of brain abscess(es). [Yes/No]
There is evidence of hydrocephalus (ventriculomegaly plus signs of elevated CSF pressure). [Yes/No]
There is evidence of ventriculitis and intraventricular infected sequestra. [Yes/No]
There are characteristic features for certain infections (i.e. HSV1 & 2, tuberculosis, etc.). [Yes/No]
Recognize the features of infection in the immuno-incompetent host (i.e. HIV, AIDS, steroid therapy, transplant patients, chemotherapy). [Yes/No]
There is evidence of raised intracranial pressure (i.e. optic hydrops, partially empty sella, and/or downward tonsillar displacement). [Yes/No]
No other significant imaging findings are present. [Yes/No]
