Presentation
Fever, high TLC count of 19 k, Generalized tonic clonic seizures and altered level of consciousness for 2 days. ? meningoencephalitis.
Patient Data
There are multiple diffusion restricted areas of varying sizes in cortex and white matter of left fronto-parietal and temporal lobes, largest one in left posterior parietal lobe is measuring approximately 2.0 x 2.4 cm in axial dimensions. Few diffusion restricted areas are also present in bilateral basal ganglia. These appear hyperintense on T2 and FLAIR images and hypointense on T1. The described imaging appearances are suggestive of subacute ischemic infarctions. There are accentuated leptomeningeal enhancement in these involved areas, this is likely due to luxury perfusion. Other less likely possibility may include focal underlying meningitis. Few tiny old lacunar infarcts are present in bilateral basal ganglia and right thalamus.
Case Discussion
Complications of acute leptomeningitis include
- hydrocephalus
- subdural empyema
- epidural empyema
- cerebritis and cerebral abscess
- infarction
- ventriculitis
- dural sinus thrombosis
The complications of meningitis can be remembered using the mnemonic HACTIVE.
Case courtesy: Assistant professor, Dr Jaideep Dareera FCPS FRCR EDIR
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