Age: 26
Sex: Female
Indication: Hydrocephalus seen on head CT, tumor?
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Case #5
Findings
- Extensive leptomeningeal enhancement along the surface of the brain and visualized upper spinal cord, with most pronounced involvement of the cerebellum, bilateral frontal and occipital lobes, and basal cisterns
- Thickening and enhancement of the left aspect of the optic chiasm
- Enhancement within the left greater than right internal auditory canals
- Asymmetric enlargement and enhancement of the choroid plexus in the right lateral ventricle with apposition of the walls of the posterior body and atrium of the right lateral ventricle
- Diffuse ventriculomegaly with periventricular T2/FLAIR hyperintensity
- Diffuse sulcal effacement with hyperintense FLAIR signal in multiple sulci along the bilateral cerebral convexities
- Inferior descent of the cerebellar tonsils into the foramen magnum with mild crowding of the upper cervical spinal cord
- No evidence of acute infarct or hemorrhage
Diagnosis
- Neurosarcoidosis
Sample Report
Communicating hydrocephalus with transependymal edema and intracranial mass effect with bilateral cerebellar tonsillar herniation. Recommend urgent neurosurgical evaluation.
Extensive leptomeningeal enhancement along the surface of the brain and visualized upper spinal cord as well as involving the ventricles and right lateral ventricular choroid plexus, for which differential considerations include neurosarcoidosis, meningitis (including mycobacterial and fungal pathogens), lymphoma, and leptomeningeal carcinomatosis. CSF analysis should be performed for further evaluation, but given potential risk for worsening tonsillar herniation with lumbar puncture, any diagnostic intervention should be directed by neurosurgery.
Evidence of cranial nerve involvement with enhancement of the left aspect of the optic chiasm and the left greater than right internal auditory canals.
No evidence of acute infarct or hemorrhage.
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