Age: 55
Sex: Female
Indication: Headache, fever
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Case #16
Findings
- T2/FLAIR hyperintensity within bilateral cerebral gyri with mild generalized gyral swelling as well as additional patchy T2/FLAIR hyperintensities in the subcortical white matter
- Diffuse leptomeningeal enhancement with multifocal sulcal FLAIR signal hyperintensity and restricted diffusion
- Material layering in the occipital horn of the right lateral ventricle with associated restricted diffusion
- Diffuse dural enhancement without discrete extraaxial collection
- Susceptibility artifact in the left sylvian fissure
- Areas of abnormal hypoenhancement in the superior sagittal sinus and right transverse and sigmoid sinuses extending to the jugular bulb. Smaller central area of hypoenhancement in the distal left transverse sinus
- Extensive T2/FLAIR hyperintensity throughout the left middle ear and left mastoid air cells
- Several small peripherally enhancing collections in the left mastoid temporal bone with the largest measuring 1 x 1 cm inferiorly with central restricted diffusion
- Query dehiscence along the left tegmen mastoideum
- Mucosal thickening of the right greater than left maxillary sinuses
- Enlarged upper left cervical chain lymph nodes
Diagnosis
- Meningitis and venous sinus thrombosis
Sample Report
Findings consistent with meningitis complicated by ventriculitis and venous sinus thrombosis involving the superior sagittal sinus, right transverse and sigmoid sinuses, and to a lesser extent the left transverse sinus. Patchy areas of subcortical T2/FLAIR hyperintensity could relate to cerebritis without evidence of parenchymal abscess or discrete extraaxial collection.
Left otomastoiditis complicated by several small abscesses in the left mastoid temporal bone. Possible dehiscence of the tegmen mastoideum, which could provide a conduit for intracranial extension and could be further evaluated by contrast-enhanced temporal bone CT.
Susceptibility artifact in the left sylvian fissure, suggesting a small amount of subarachnoid hemorrhage.
Discussion
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References
- Fukui MB, Williams RL, Mudigonda S. CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol 2001; 22(8): 1510-1516.
- . Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-pathologic correlation and historical perspectives. Radiographics 2015; 35(4): 1141-1169.
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