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.
MR diffusion
1. The DWI map findings are consistent with acute leptomeningeal infection. There is no restriction within the brain nor extraaxial spaces.
MR SWI
1. SWI evidence of post inflammatory venous hyperemia.
2. There is no acute microhemorrhage.
Dicom
Findings
| MR T2-w turbo spin-echo | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of leptomeningitis. |
No | NA |
|
There is evidence of primary pachymeningitis. |
No | NA |
|
There is evidence of secondary pachymeningitis from extracranial infection site. |
No | NA |
|
There is evidence of cerebritis. |
No | NA |
|
There is evidence of brain abscess(es). |
No | NA |
|
There is evidence of hydrocephalus (ventriculomegaly plus signs of elevated CSF pressure). |
No | NA |
|
There is evidence of ventriculitis and intraventricular infected sequestra. |
No | NA |
|
There are characteristic features for certain infections (i.e. HSV1 & 2, tuberculosis, etc.). |
No | NA |
|
Recognize the features of infection in the immuno-incompetent host (i.e. HIV, AIDS, steroid therapy, transplant patients, chemotherapy). |
No | NA |
|
There is evidence of raised intracranial pressure (i.e. optic hydrops, partially empty sella, and/or downward tonsillar displacement). |
Yes | 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)
