21-year-old male:
* Collapse twice
* Loss of strength of right arm
* Trouble finding words
* Headache
What findings do you see on the CT?
CT Findings
* No abnormalities were seen
* No bleeding
* No signs of recent ischemia
Patient develops fever. Cannot bend his neck properly. When asked, he has been traveling recently to Thailand.
What further imaging could help us?
An MRI is performed.
What findings do you see on the MRI?
MRI Findings
* Two areas left frontal and left parietal with T2/FLAIR hyperintense swelling/edema of cortex and subcortical white matter, with diffusion restriction and patchy, gyriform cortical enhancement
* Diffusely leptomeningeal enhancement
* No ring-enhancing lesions. No white matter vasogenic or cytotoxic edema
What is the most likely diagnosis?
Cerebritis (precursor of abscess) and meningitis. Not yet an abscess
Note: Encephalitis means inflammation of PARENCHYMA
Differential diagnosis of meningitis:
> Leptomeningeal carcinomatosis
> Sarcoidosis and other granulomatous diseases
> Vasculitis
> Connective tissue diseases
Viral inflammatory cause for symptoms was confirmed with lumbar puncture and patient was treated with IV anti-viral treatment
