Presentation
Presenting to ER with fever, headache, vomiting and decreased level of consciousness.
Patient Data
There are swelling and increased signal intensity of the right frontal lobe with edematous changes and midline shift to left side associated with meningeal and intraparenchymal enhancement in the right frontal lobe indicating meningoencephalitis.
A small collection is seen overlying the right anterior frontal region, measuring around seven millimeters in thickness with mass effect.
Two small ring-enhancing lesions are also seen in the right frontal lobe, suggesting abscess formation.
Subdural collections are also seen along the interhemispheric fissure at the right side of fronto-parieto-occipital regions with extension laterally along the right side of tentorium measures one in half centimeter in maximum thickness, suggesting subdural empyema.
All the above findings are causing restricted diffusion.
Changes of paranasal sinusitis are seen.
Dilated tortuous optic nerves are noticeable bilaterally indicating increased intracranial pressure.
Case Discussion
Upon initial evaluation bacterial meningitis was confirmed. MRI of the brain with contrast administration was requested and showed mild swelling of the right frontal cortex compared to the other side which was better appreciated on T2WI, with meningeal thickening and enhancement of this region as well. Paranasal sinusitis was also seen indicating intracranial extension of infection.
Brain MRI one month later was done due to further clinical deterioration of the patient unfortunately demonstrating the above findings.
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