Case Notes
History
61 yo male with lung cancer who presented with infected G-tube and flank pain; already on antibiotics. Clinically, he was thought to have a flank abscess. He already has had a right frontal ventriculostomy placed at the time af admission. He had increasing headaches and persistent fever.Exam
MR T1-w post contrast
Prior Study
MR flair1. Fulminant acute leptomeningitis with findings in the acute inflammatory phase (>3 days).
2. The pial reaction is extensive (acute pachymeningitis, not chronic pachymeningitis) covering the hypothalamus and pituitary stalk and producing acute hydrocephalus grade 1.2/4.
3. There is enhancement along the surfaces of multiple cranial nerves; correlate for symptoms of acute neuritis.
4. There is early upward transtentorial herniation from cerebellar swelling.