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 susceptibility (SWI)
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.
MR T1-w post contrast
1. There is contrast enhancement of the pia and the dura consistent with changes in the inflammatory phase (>3 days). The leptomeningitis has two components: 1. a basilar pachymeningitic component, and 2. a less aggressive cortical component.
2. There is contrast enhancement of cranial nerves (CN5, 6, 7 & 8) consistent in inflammatory neuritis. There is also enhancement of hypothalamus, pituitary stalk, and pituitary gland of indeterminate significance.
3. There are likely left cavernous sinus and possible left sphenoparietal sinus thromboses.