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Age: 80

Sex: Male

Indication: Meningitis

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Case #23


Findings

  • Area of T2/FLAIR signal hyperintensity centered in the left inferior temporal gyrus with mild gyral expansion and associated central restricted diffusion and faint peripheral enhancement. Faint T2 hypointense rim about the area of restricted diffusion in the left temporal lobe
  • Additional areas of FLAIR signal hyperintensity and restricted diffusion within left parietooccipital sulci as well as layering in the occipital horns of the bilateral lateral ventricles with mild diffuse dural thickening and enhancement
  • Fluid signal in the bilateral middle ears and mastoid air cells
  • Patchy periventricular T2/FLAIR hyperintensity
  • No acute hemorrhage or hydrocephalus


Diagnosis

  • Cerebritis

Sample Report

Findings concerning for late cerebritis/early abscess in the left inferior temporal gyrus with evidence of meningitis and ventriculitis. These findings likely represent a complication of left ostomastoiditis given proximity, which could be further evaluated with contrast-enhanced temporal bone CT. Recommend ENT and neurosurgical consultation.

Mild associated mass effect without midline shift, herniation, or hydrocephalus. No acute hemorrhage.

Patchy periventricular T2/FLAIR hyperintensity is nonspecific but commonly attributable to chronic small vessel disease.


Discussion

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Images

1 week followup imaging in this patient (bottom two images) shows progression from late cerebritis to abscess with development of peripheral enhancement and persistent central restricted diffusion. Restricted diffusion in the dependent aspects of the occipital horns of both lateral ventricles (red arrows), concerning for ventriculitis.



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