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Leptomeningitis with supratentorial hydrocephalus and multifocal cerebritis

Case contributed by Mohammad A. ElBeialy
Diagnosis almost certain

Presentation

Three day history of fever, convulsions and disturbed level of consciousness.

Patient Data

Age: 2 months
Gender: Female

Diffuse leptomeningeal thickening and enhancement is seen with small bilateral frontal subdural marginally-enhancing collections. Mild supra-tentorial hydrocephalic changes are seen. Multiple bilateral patchy areas of altered signal intensity are seen within bilateral frontal lobes, bilateral basal ganglia and deep parietal lobes, as well as bilateral occipital, temporal, high fronto-parietal  (centrum semiovale) and the splenium of the corpus callosum. Lesions show low T1 and high T2 / FLAIR signal intensity with evident restricted diffusion.

No sellar or juxta-sellar mass lesions. Normal cerebellum, brain stem and cervicomedullary junction. 

Case Discussion

Diffuse leptomeningitis with mild supra-tentorial hydrocephalus, as well as multi-focal patchy cerebritis and small bilateral frontal subdural collection.

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