Case Images
Case Notes
History
21 yo male presenting with acute headache, meningismus, and pleocytosis on CSF analysisExam
MR susceptibility (SWI)
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.
MR diffusion
1. The DWI map findings are consistent with acute leptomeningeal infection. There is no restriction within the brain nor extraaxial spaces.
Dicom
Findings
You scored:
0
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9
| MR susceptibility (SWI) | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of pial microhemorrhage. |
No | NA |
|
There is evidence of parenchymal or subependymal microhemorrhage. |
No | NA |
|
There is evidence of pial arterial inflammatory hyperemia. |
Yes | NA |
|
There is evidence of increased deep medullary venous drainage from inflammatory hyperemia. |
No | NA |
|
There is evidence of reduced pial arterial size consistent with pial vasospasm. |
No | NA |
|
There is evidence of reduced or absent deep venous filling consistent with metarteriole vasospasm. |
No | NA |
|
There is evidence of arterial and venous hyperemia consistent with an AV fistula. |
No | NA |
|
There is evidence of venous blooming effect associated the venous stasis. |
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)
