Female, 73 years old, with bilateral uveitis, headache, blurry vision, possible TB versus GCA versus other. The dura overlying the bilateral frontal and anterior temporal lobes remains smoothly thickened and enhancing. More posteriorly, these findings diminish and the dura is becomes relatively unremarkable. In the areas where dural thickening is most pronounced, thin bilateral subdural collections are redemonstrated measuring up to 5 mm in thickness, previously 6 mm. The collections overlie the lateral aspects of the frontal lobes and do not extend more superiorly or posteriorly. No enhancement is seen along the inner margins of these collections and there is no convincing associated susceptibility effect.No evidence of any pathologic leptomeningeal or parenchymal enhancement is seen. No acute intracranial hemorrhage is detected. Diffusion-weighted images are within normal limits. Scattered foci of periventricular and subcortical FLAIR hyperintensity are redemonstrated, similar to prior. Ventricular size morphology are within normal limits.
Smooth dural thickening and enhancement persists, similar to the prior examination, predominantly affecting the frontal and anterior temporal regions. Small subdural collections along the lateral aspects of the frontal lobes are slightly reduced in size. Scattered parenchymal foci of signal abnormality are unchanged and nonspecific.The etiology of the above findings remains uncertain. The differential diagnosis would include changes in intracranial pressure which could account for both the dural thickening and the small bilateral subdural collections. Alternately, the dural thickening may be reactive to the collections. The collections themselves do not demonstrate typical features of empyema, though an atypical infectious etiology could certainly be considered. Finally, noninfectious inflammatory, granulomatous and/or autoimmune conditions remain in the differential.