Presentation
Fever with recurrent multiple fitting episodes for 3 days.
Patient Data
Focal hypodense area at the left frontal lobe (parasagittal location) which is mainly confined within the white matter. No focal enhancing wall or brain lesion. Abnormal leptomeningeal enhancement at bifrontal region and anterior vertex.
Widening of bifrontal and anterior interhemispheric CSF spaces with no flattening of adjacent gyri may represent beningn enlargement of subarachnoid spaces in infancy (BESSI). Crossing vessels seen across these bifrontal subarachnoid spaces. However, higher attenuation within the left frontal subarachnoid space (15 HU) compared to the right side ( 8HU).
Slight ballooning of temporal horns of both lateral ventricles may represent early hydrocephalus.
Annotated images showed left frontal vasogenic edema which can represent early cerebritis, as well as sites of abnormal leptomeningeal enhancement at vertex.
Slight ballooning of the temporal horn of right lateral ventricle can represent early hydrocephalus. Temporal horn would be the first site to be dilated in the case of hydrocephalus. Sensitive to detect early hydrocephalus before the full blown hydrocephalus.
Case Discussion
Left frontal vasogenic edema may suggest the diagnosis of early cerebritis where absence of definite wall enhancement rules out the possibility of cerebral abscess. The higher attenuating content of left subarachnoid space and abnormal leptomeningeal enhancement are secondary due to infection.
Lumbar puncture confirmed the diagnosis of meningitis.
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