C/O fever and confusion. Patient was HIV positive.
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Mild Ventriculomegaly. Restriction on diffusion in the periventricular region along bilateral lateral ventricles. Minimal ependymal enhancement on contrast administration. MRI features likely representing ventriculitis.
Usually the most frequent sign of ventriculitis is intraventricular debris and pus. Abnormal periventricular intensities or enhancements are also seen. Both FLAIR and DWI sequences contribute to the diagnosis of ventriculitis.
Periventricular hyperintensities are generally present around the anterior and posterior horns of lateral ventricle in ventriculitis. If patient has hydrocephalus it can due to CSF ooze. In old patients this finding could be confused with chronic ischemic changes. DWI generally is helpful in differentiating these conditions from ventriculitis. Post gadolinium administration also shows enhancement along the ventricular walls.
In this case there was subtle enhancement along the ventricular walls. However, there was significant restriction on DWi and high signal intensity on FLAIR sequences. The T2W image also shows periventricular hyperintensity, but it is difficult to differentiate from adjacent CSF in the ventricles.
This patient had positive CMV IgG and IgM.