1. Acute cerebral infarcts in bilateral ACA and left MCA distribution. Scattered foci of abnormal diffusion throughout the brain may represent a combination of septic thrombotic-embolic components and pial/leptomeningeal process.
2. Abnormal signal in right mastoid and petrous apex consistent with petro-mastoiditis/osteomyelitis with intracranial complications, including thrombosis of the right transverse sinus, sigmoid and jugular vein. There is also bilateral cavernous sinus thrombosis/thrombophlebitis, right greater than left, with pseudoaneurysm of the right cavernous internal carotid artery.
3. Hemorrhage and phlegmonous enhancement within the basilar cisterns, concerning for basilar meningitis. There is also abnormal enhancement of the cranial nerves consistent with leptomeningeal process. No definite basilar tip aneurysm; however, either diagnostic angiogram or CT angiography will be helpful for further delineation.
4. Multifocal intracranial arterial stenoses, which may be seen with vasculitis and vasospasm.
5. Mild ventriculomegaly and intraventricular hemorrhage.
(Severe complicated otomastoiditis/skull base osteomyelitis)
Study description: MRI MRA BRAIN WITH AND WITHOUT CONTRAST