Case Notes
History
17 month old male who presented with headaches, vomiting, and fever. He was diagnosed with bacterial meningitis and Rx with antibiotics. Symptoms did not resolve and MR was obtained.Exam
MR T2-w turbo spin-echo
Prior Study
MR flair1. There are features of hyperacute leptomeningitis.
2. There is apparently aggressive posterior ethmoid and sphenoid sinusitis. This could be the source on the acute leptomeningitis.
3. There is early hydrocephalus with intraventricular debris in the occiptal horns; this could represent infected intraventricular coagulum.
MR post contrast T1-w
1. There is evidence of an aggressive sphenoethmoid pyogenic infection extending through bone into the epidural space and dura producing local acute pachymeningitis, as well as, linear small volume epidural abscess. There is secondary more acute leptomeningitis over the convexities.
2. There is a dehsicence in the sphenoid dura, which likely is the source of the more acute leptomeningitis.
3. There is bilateral cavernous sinus thrombophlebitis; there is frank intrasinus abscess on the left.
4. There is cranial neuritis affecting the left 5th CN ganglion and the distal CN 7 & 8 within the IAC.
MR diffusion
1. Restricted diffusion is evident in the material within the ventricular trigones consistent with infected sequestra.
2. Restricted diffusion is evident at least in the left subfrontal epidural abscess.
MR GRE rather than SWI
1. There are infected sequestra within the ventricular trigones; there is no hemorrhage.