Headaches, low-grade fever, and deterioration of the level of consciousness.
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The MRI sequences demonstrate:
- a lobulated intra-axial mass in the right temporal region isointense to the cortical grey matter on T1WI with peripheral hyperintense rim (paramagnetic material), hypointense on T2WI/FLAIR with a cluster of ring enhancement on postcontrast sequences. A large area of surrounding vasogenic edema is noted extending to the internal/external capsules with a mass effect on the temporal horn and midbrain. The multivoxel MR spectroscopy reveals a dominant peak in Lipids / Lactate (LL). Findings are most consistent with tuberculous granuloma (or tuberculoma).
- the cortical grey matter at the frontal parasagittal regions appears thickened isointense on T1WI, hyperintense on T2WI/FLAIR with mild gyral enhancement on postcontrast sequences and restricted diffusion indicating most likely a focal cerebritis.
- meningeal enhancement of basal subarachnoid cisterns, along the middle cerebral arteries to the Sylvian fissures and cerebral hemispheres well-visualized on postcontrast FLAIR fat saturation (despite the motion artifact), in keeping with meningitis.
- Mild dilatation of the 3rd and lateral ventricles in keeping with obstructive hydrocephalus.