Demographics:
15 months old, Female
Indication:
Meningitis, lethargic
Findings
- Severe diffuse ventriculomegaly with widespread periventricular T2/FLAIR hyperintensity, particularly in the parietooccipital regions, and diffuse ependymal enhancement
- Intermediate T2 signal material layering in the lateral, third, and fourth ventricles with associated restricted diffusion but no susceptibility artifact
- Peripherally enhancing subdural collections overlying the bilateral frontal and parietal convexities with associated restricted diffusion, measuring up to 7 mm in thickness on the left and 5 mm in thickness on the right
- Diffuse leptomeningeal and pachymeningeal enhancement
- Multiple small areas of susceptibility artifact in the bilateral cerebral hemispheres, most concentrated in the frontal lobes
- Generalized cerebral sulcal effacement and partial effacement of the basal cisterns. No cerebellar tonsillar herniation
- Partially imaged airspace disease in the right lung apex
Diagnosis
Ventriculitis
Sample Report
Findings concerning for meningitis complicated by diffuse ventriculitis with pus layering in the ventricles, bilateral subdural empyemas, and multiple small cerebral parenchymal hematomas.
Resultant severe communicating hydrocephalus with subependymal edema and associated mass effect with generalized cerebral sulcal effacement and partial effacement of the basal cisterns. No cerebellar tonsillar herniation.
No evidence of proximal arterial occlusion, venous sinus thrombosis, or acute infarct.
Partially imaged airspace disease in the right lung apex, which may represent atelectasis or pneumonia.
Discussion