Clinical question: 40-year-old with presumed viral meningoencephalitis and worsening neuro exam. Please reevaluate with Fiesta sequence. Signs and symptoms: Abnormal gaze, weakness and decreased tone. Pre and post enhanced brain MRI:Unremarkable diffusion weighted images.Examination demonstrates subtle diffuse FLAIR hyperintensity of bilateral cerebellar hemispheres and vermis (more conspicuous in the left cerebellum) with evidence of subtle associated mass effect however without hemorrhagic changes. This finding demonstrate diffuse enhancement on post enhanced series. Findings are suggestive of an inflammatory/infectious process and meningoencephalitis should be considered.There is no convincing evidence of signal abnormality of pons, medulla or the cerebral hemispheres and without abnormal enhancement.There is mild decreased size of fourth ventricle secondary to mass effect however the supratentorial ventricular system remain within normal size and without deviation of midline. The quadrigeminal plate and the cisterna magna remain patent.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are within normal with normal pattern of enhancement.Pre- and post enhanced total spine MRI:Images through the cervical spine are degraded in particular on sagittal T2 STIR and post enhanced series. Within this limitation there is no convincing evidence of signal abnormality of the cord or abnormal enhancement. No spinal stenosis or neural foraminal compromise is detected.Examination of the thoracolumbar spine demonstrate no evidence of cord signal abnormality or increased cord caliber and without detectable abnormal enhancement. No spinal stenosis or neural foraminal compromise at any level.Normal signal intensity and morphology of cauda equina without abnormal enhancement.Findings and concerns on this exam were discussed by phone with the clinical service Christine Carlos pager # 3729 at the time of review of the study at 8:15 AM.
1.Pre and postcontrast enhanced brain MRI demonstrates subtle diffuse FLAIR hyperintensity of cerebellar hemispheres and vermis and with diffuse enhancement however without associated hemorrhage or significant mass effect. Findings are highly suggestive of an inflammatory process and including meningoencephalitis. Unremarkable images through supratentorial space and without convincing evidence of abnormal signal intensity or enhancement.2.Pre- and post enhanced total spine MRI demonstrate no convincing evidence of abnormal cord signal intensity or abnormal enhancement.