Viral meningitis

Case contributed by Dr David Mitchell

Presentation

Headache and fever. CSF lymphocytosis on lumbar puncture.

Patient Data

Age: 35 years
CT

CT

Normal CT study. No intracranial hemorrhage or acute infarction. Normal grey white matter differentiation. No abnormal contrast enhancing lesions. The basal cisterns are normal. Ventricular and sulcal size are age appropriate. No extra-axial abnormality.
MRI

MRI

Although not visible on post-contrast T1 and pre-contrast FLAIR, there is extensive smooth thin sulcal enhancement on the more sensitive post-contrast FLAIR sequence.

Case Discussion

Although not visible on post-contrast T1 and pre-contrast FLAIR, there is extensive smooth thin sulcal enhancement on the more sensitive post-contrast FLAIR sequence. The CT is normal and the remainder of the MRI is normal.

Diffuse leptomeningeal enhancement is in-keeping with meningitis. The lumbar puncture demonstrated clear and colourless CSF with a CSF lymphocytosis. The gram stain and culture were negative. The differential in this case includes viral meningitis, or less likely TB or fungal meningitis.

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Case information

rID: 61244
Published: 24th Jun 2018
Last edited: 8th Aug 2018
Inclusion in quiz mode: Included

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