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Leptomeningeal Enhancement
A 44-year-old man who had upper respiratory infection symptoms 4 weeks earlier now presenting with severe headache, purulent otorrhea, irritability, and progressive decline of mental status. Ax , axial; Cor , coronal; Sag , sagittal.
A 38-year-old woman with a history of diabetes insipidus and hyperprolactinemia presenting with a complex partial seizure. Ax , axial; Cor , coronal; Sag , sagittal.
A 58-year-old woman with 5-week history of fever and headache now presenting with increasing confusion, vomiting, and lethargy. Ax , axial; Cor , coronal; Sag , sagittal.
A 2-year-old girl with a history of seizures presenting with a decline in language function. Ax , axial; Cor , coronal; Sag , sagittal.
A 22-year-old man recently diagnosed with communicating hydrocephalus of unknown cause now presenting with intractable headaches, lightheadedness, and episodes of near syncope. Ax , axial; Cor , coronal; Sag , sagittal.
DESCRIPTION OF FINDINGS
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Case A: There is a thin, smooth pattern of leptomeningeal enhancement with left mastoiditis evident as the source of infection.
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Case B: There is a markedly nodular pattern of leptomeningeal enhancement slightly more prominent in the basal cisterns and the hypothalamic region. There is also bilateral trigeminal nerve involvement. Thoracic imaging (not shown) demonstrated mediastinal and pulmonary sarcoidosis.
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Case C: There is a thick and nodular pattern of leptomeningeal enhancement predominantly involving the basilar cisterns.
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Case D: A thin, smooth pattern of right temporal parietal leptomeningeal enhancement is noted. There is associated cortical atrophy, ipsilateral choroid plexus hypertrophy, and a prominent medullary vein. A port-wine stain was seen on physical exam.
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Case E: There is very thick, smooth leptomeningeal enhancement predominantly involving the basilar cisterns.
Diagnosis
Case A
Bacterial meningitis
Case B
Neurosarcoidosis
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