Clinical question: Evaluate for change to previously demonstrated left cerebellar lesion after 2 weeks of antibiotics treatment. Signs and symptoms: Left cerebellar lesion; normal neurological exam. Pre and post enhanced brain MRI:A ring-enhancing lesion in the left cerebellar measuring at 6 x 8 mm in transaxial dimensions compared to prior study measurement of 11 x 7 mm. Trace residual FLAIR hyperintensity surrounding this lesion demonstrate significant decrease since prior exam. This patient similar to prior study demonstrate restricted diffusion which due to its small size it is difficult to assess for change in size.Stable punctate focus of ependymal enhancement of the left occipital horn since prior exam.There is revisualization of uniform thin linear enhancement of the ependymal lining of the right trigone and occipital horn of lateral ventricle without definitive interval change since prior exam. There is also significant decreased associated FLAIR hyperintensity surrounding the trigone and occipital horn of right lateral ventricle since prior study suggestive of improvement. This finding also demonstrate linear restricted diffusion which may be slightly less conspicuous compared to prior study.Mild leptomeningeal enhancement along the superior aspect of bilateral cerebellar hemispheres (L>R) is again noted and also demonstrate interval improvement since prior exam. There is no evidence of any additional new foci of restricted diffusion, FLAIR/T2 hyperintensity or abnormal parenchymal, meningeal or ependymal enhancement.Ventricular system remains within normal size and without radiation of midline. All CSF cisterns remain patent. The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses is within normal with normal pattern of enhancement.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and calvarium.
1.Interval improvement evident by decreased size, associated edema and decreased conspicuity of restricted diffusion of multiple foci of enhancement consistent with small abscess in left cerebellum, cerebellar leptomeningeal infection and bilateral ventriculitis since prior study as detailed/measured above.2.Unremarkable pre and postcontrast enhanced brain MRI otherwise and without evidence of any new foci of restricted diffusion, abnormal FLAIR hyperintensity or abnormal enhancement.