Case Notes
History
2 yo male (born prematurely) who now presents with weakness, Rt. facial paresis and fever. CSF was negative for pathogensExam
MR T2-w turbo spin-echo
Prior Study
MR flair1. Findings are consistent with hyperacute leptomeningitis and possibly early ventriculitis.
MR T1-w post contrast
1. Subtle pial surface contrast enhancement consistent with proinflammatory contrast leak without evidence of cerebritis or extraaxial empyema.
MR susceptibility (SWI)
1. There is microhemorrhage along the pial surface of the brain mainly in the proximal sylvian fissures. There is subtle pial microhemorrhage along the right lateroventral temporal lobe. There is intraaxial microhemorrhage in right frontal major forceps of the corpus callosum. These findings added to the leptomeningitis and possibly ventriculitis findings are strongly supportive of infection by viruses, like herpes simplex which have an angiophillic affinity.