Case Images
Case Notes
History
27 yo male presenting with acute exacerbation of headaches, nausea, vomiting, unsteadiness, malaise, and blurry vision; symptoms have been increasing over 3 weeks. Patient has had prior placement of a right ventriculostomy.Exam
MR T2-w turbo spin-echo
Prior Study
MR flair1. There is acute obstructive hydrocephalus, likely related to obstruction of the caudal 4th ventricle where intraventricular cystic lesion is evident.
2. The hydrocephalus is acute and graded at 1.8/4, which accounts for the early downward central incisural herniation.
3. There is diffuse sulcal high protein, which could be from active leptomeningitis or be related to the CNS infection causing elevated protein concentration in the CSF.
MR T1-w post contrast
1. There is a well marginated cyst with scolex within the 4th ventricle. Findings are consistent with neurocystercercosis.
2. There is acute obstructive hydrocephalus related to an infectious cyst in the 4th ventricle; there is no evidence of obvious ventriculitis.
3. There is pial hyperemia and leak of contrast into the sulci consistent with low-grade leptomeningitis likely in the proinflammatory phase.
MR diffusion
1. MR diffusion changes with the scolex part of the 4th ventricular cyst demonstrating positive diffusion restriction and the cystic part demonstrating only T2-w shine-through.
