Case Images
Case Notes
History
21 yo male presenting with acute headache, meningismus, and pleocytosis on CSF analysisExam
Prior Study
MR flair1. There is evidence of hyperacute, primary, leptomeningitis. There is no evidence of abscess formation.
MR T1-w post contrast
1. There is abnormal leak of contrast into sulci over much of the brain plus evidence of venous hyperemia. These findings are consistent with the hyperacute phase of leptomeningitis.
2. There is evidence of early raised intracranial pressure.
Dicom
Findings
| MR diffusion | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of a cortical/subcortical T2-shine through on diffusion consistent with leptomeningitis, or evidence of T2 shine through within brain parenchyma consistent with cerebritis/cerebellitis/rhombencephalitis. |
Yes | NA |
|
There is evidence of a parenchymal abscess or intraventricular infected sequestra with positive fluid restriction (i.e. positive DWI and positive ADC). |
No | NA |
|
There is evidence of an extraaxial empyema with T2 shine-through (positive DWI/negative ADC: both hyperintense). |
No | NA |
|
There is evidence of an extraaxial empyema with adjacent bone osteomyelitis having positive fluid restriction (positive DWI/positive ADC: DWI hyperintense/ADC hypointense) in both areas. |
No | NA |
|
There is evidence of secondary arterial ischemic event. |
No | NA |
|
No other significant imaging findings are present. |
No | NA |
Impression
Expert Answer
All of the above answers are correct.
Your Answer
Recommendations & Acuity
Recommendations
Expert Answer
Proceed with additional MR imaging sequences.
Your Answer
Acuity
Expert Answer
Emergent (Action Necessary now)
