Neuro_MR_Brain: 17 M, headache and fever.

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 17 years of age, Male, concern for basilar meningitis.

FINDINGS:

There is extensive leptomeningeal enhancement within the infratentorial brain and around the brainstem, as well as and throughout the basal cisterns and within the right greater than left Sylvian fissures. Bilateral cranial nerve III are enhancing diffusely and possible enhancement of CNVs and VII/VIII complexes. Additionally there are multiple more focal nodular areas of enhancement, some of which may be leptomeningeal whereas others appear parenchymal. There is some associated edema with the majority of the nodules. 

The enhancing nodules are listed below:

- 3 mm nodule over the left cerebellar hemisphere (se12/ im32)

-Additional 3 to 4 mm nodule also within the left cerebellar hemisphere (12/38)

-3 to 4 mm nodule along the superior right cerebellar hemisphere (12/58)

-4 mm nodule of the right temporal operculum (12/81)

-Punctate nodule within the paramedian right occipital lobe (12/71)

-Punctate focus of enhancement in the right caudate head (17/19)

-Punctate focus in the left temporal lobe (12/34)

There is difuse prominence of the ventricles and sulci, nonspecific. 

No abnormal extracerebral collections are present.

The orbital contents are without abnormality.

The visualized paranasal sinuses and mastoid air cells are clear.

There is an enlarged right lateral retropharyngeal node measuring 1.7 x 1.1 cm. Additional partially visualized lymph nodes are present in the right greater than left upper neck.

IMPRESSION:

1.  Diffuse abnormal linear and nodular leptomeningeal enhancement, most pronounced within the basilar cisterns, and several intraparenchymal enhancing nodules. In light of the provided history , the appearance is most concerning for atypical infection such as mycobacterial infection, specifically tuberculosis, or fungal infection. The imaging differential also includes metastatic disease or noninfectious inflammatory processes, although these are considered less likely.

2.  Partially visualized enlarged cervical lymph nodes.

3.  Mildly prominent ventricles and sulci.

(Coccidioidomycosis meningitis)