51 years Male (DOB:12/3/1964)Reason: h/o meningoencephalitis - evaluate History: confusionPROVIDER/ATTENDING NAME: JESSICA PENTZ RIDGWAY JESSICA PENTZ RIDGWAY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Since the prior exam leptomeningeal enhancement predominantly involving posterior fossa structures has regressed and is not visible. There are several subtle enhancing nodules present adjacent to the quadrigeminal plate which demonstrate enhancement. Another small nodule is present adjacent to the left trigeminal nerve root origin. To have a ring-enhancing appearance and measure 4 mm diameter and one is more solid in appearance and measures 4 mm in diameter. These were not present on the prior exam. There are some subtle leptomeningeal enhancement present surrounding the upper brainstem. FLAIR signal hyperintensity is present along the surface of the entire brainstem.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is some residual/persistent nodules present adjacent to the quadrigeminal plate and the left trigeminal nerve root origin which were not present on the prior exam representing some residual meningitis. The amount of the leptomeningeal enhancement in the posterior fossa has significantly regressed but not completely resolved.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 