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CB1188

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Case Notes

History

6 yo male presenting with fever, right preseptal cellulitis, then a seizure

Exam

Prior Study

MR flair
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.

Dicom

 
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Submit Findings

CB1188

Findings

MR diffusion

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.

There is evidence of a parenchymal abscess or intraventricular infected sequestra with positive fluid restriction (i.e. positive DWI and positive ADC).

There is evidence of an extraaxial empyema with T2 shine-through (positive DWI/negative ADC: both hyperintense).

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.

There is evidence of secondary arterial ischemic event.

No other significant imaging findings are present.