Multiple pachymeningeal-based peripherally-enhancing lesions are present along the inferior aspect of the right cerebral hemisphere, the posterior petrous ridge bilaterally, and adjacent to the left petrous apex along the lateral aspect of the cavernous sinus and the floor of the middle cranial fossa medially. There are further smaller lesions overlying the right temporal pole and along the inferolateral aspect of the left frontal lobe. All lesions are 1-2 cm in size and demonstrate relatively low T2 signal centrally. Adjacent T2 hyperintense parenchymal signal is nonenhancing and in keeping with oedema. The parenchymal change within the inferior right cerebellar hemisphere is associated with some restricted diffusion. There is no definite inflammatory change within the orbital apex. Although the lesion adjacent to the left petrous apex is inseparable from the left trigeminal nerve within the pre-pontine cistern, there is no convincing cranial nerve enhancement. There is associated nodular heterotopia along both lateral ventricular margins. The most likely aetiology is an inflammatory pachymeningeal disease, with differential diagnoses including sarcoidosis, vasculitis or atypical infection. Haematologic or metastatic disease are also possible causes for these changes, but are less likely.