Case Notes
History
30 yo male presenting with fever and sinusitis initially then depressed level of consciousnessExam
MR diffusion
Prior Study
MR flair1. Aggressive left ethmoid sinus resulting in a focal relative large empyema adjacent to the ethmoid bone dehiscence in the left basifrontal area.
2. Secondary, mainly left sided, acute phase leptomeningitis with multicentric bilateral smaller subdural empyemas.
MR post contrast T1-w axial and coronal planes
1. There are bilateral relative small (3-5 mm) in width subdural hematomas which are nearly pan hemispheric on the left and scattered on the right. Focal larger (12-14 mms) subdural empyema's are evident in the left basifrontal and left frontopolar areas.
2. There is diffuse venous hyperemia and actual pial/dural enhancement along the lateral surface of the left cerebrum indicating the leptomeningitis is likely >3 days in evolution.
3. Abnormal enhancement is evident in the left sphenoparietal sinus indicating there is underlying thrombophlebitis, which likely contributes to the spread of the subdural empyemas.
4. There is no evidence of ventriculitis, cerebritis, nor brain abscess at this time.