Presentation
Diabetic male patient with past history of pansinusitis. Left proptosis three weeks before. Recently admitted with fever for further evaluation. The patient recently started on anticoagulant therapy.
Patient Data
Orbitofrontal cerebritis with bifrontal hypodense area involving orbitofrontal cortex, predominantly left sided. Effacement of frontal horns caused by vasogenic edema. Hemorrhage is seen at the right frontal area. Left orbital endophthalmitis and preseptal cellulitis
There is evidence of bifrontal cerebritis, predominantly left sided, demonstrated with low signal area in T1w, high signal on T2w and FLAIR. This area shows restricted diffusion present as bright signal on DWI, dark on ADC.
T2 Gradient shows a dark area in the right frontal lobe related to hyperacute hemorrhage seen on the CT study. Hyperacute hemorrhage can be low signal on T1w and high signal on T2w.
Vasogenic edema is seen on this frontal lesion as low signal on T1w, high signal on T2w, FLAIR and gradient echo. This does not demonstrate restricted diffusion.
Age-related involutional brain changes with widening of the ventricles, Sylvian fissures, and superficial sulci. Periventricular white matter changes.
Left eye endophthalmitis with high FLAIR signal in the vitreous humor, subtle preseptal and scleral thickening. Shrunken deformed left globe with the dislocated lens.
Pansinusitis improved.
Case Discussion
Orbitofrontal cerebritis is sequelae of pansinusitis, endophthalmitis. Regions of restricted diffusion mainly due to ischemia and hypercellularity. Hyperacute hemorrhage can be easily missed on MRI sequences except on T2 GE.
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