Age: 21
Sex: Male
Indication: Headache, history of AIDS
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Case #26
Findings
- Diffuse areas of FLAIR signal hyperintensity in the subarachnoid spaces predominantly overlying the cerebellum but also at multiple supratentorial sites
- Faint widespread leptomeningeal enhancement, particularly along the cerebellum
- Areas of rounded T2/FLAIR hyperintensity as well as dilated perivascular spaces with corresponding restricted diffusion within the bilateral cerebellar hemispheres
- Additional areas of patchy T2/FLAIR hyperintensity and foci of restricted diffusion involving the bilateral basal ganglia and cerebral cortex/subcortical white matter
- Mass effect in the posterior fossa with compression of the fourth ventricle and partial effacement of the basal cisterns
- No evidence of acute infarct, intracranial hemorrhage, or hydrocephalus
- T1/T2 hyperintensity along the posterior aspect of the right globe in the subretinal space converging on the site of optic nerve attachment
- Irregular contour of the anterior nasal sclera of the left globe with focal outpouching and layering T2 hypointense material in the left vitreous chamber
Diagnosis
- Cryptococcal meningitis
Sample Report
Meningitis and multifocal parenchymal signal abnormality involving the cerebellum more so than the supratentorial brain with morphology in the cerebellum suggestive of gelatinous pseudocyst formation within dilated perivascular spaces, which is a typical imaging appearance for cryptococcal meningitis.
Infratentorial mass effect with compression of the fourth ventricle and partial effacement of the basal cisterns. While there is no evidence of herniation or hydrocephalus at this time, recommend short interval followup imaging as this patient is at high risk for developing hydrocephalus.
Findings concerning for retinal detachment involving the right globe with subretinal hemorrhage. Exudative retinal detachment is a consideration given cryptococcal meningitis. Left globe deformity involving the anteronasal sclera could relate to increased intraocular pressure with nonspecific material layering in the left vitreous chamber. Recommend urgent ophthalmologic evaluation.
Discussion
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References
- . Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-pathologic correlation and historical perspectives. Radiographics 2015; 35(4): 1141-1169.
- Smith AB, Smirniotopoulos JG, Rushing EJ. From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic–pathologic correlation Radiographics 2008; 28: 2033-2058.
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