Headache, nuchal rigidity, intraventricular hemorrhage, possible tumor There is diffusion restriction involving the splenium and body of the corpus callosum compatible with acute ischemic infarction. There is an approximately 2.4 x 1.3 cm expansile area involving the body of the corpus callosum with peripheral T1 hyperintensity consistent with acute/subacute hemorrhage, compatible to recent head CT findings. There is redemonstration of intraventricular extension of hemorrhage. The lateral ventricles are not significantly distended. On intracranial arterial wall imaging sequences, diffuse segmental arterial luminal stenosis of bilateral supraclinoid internal carotid arteries, especially beyond the level of distal dural ring are demonstrated. In addition, bilateral distal vertebral arteries especially beyond the level of dural coverage appear to be narrowed in luminal diameter. However, no definite arterial wall thickening are seen. In addition, there is no evidence of wall enhancement. Other intracranial vasculature including bilateral proximal MCAs and basilar artery also appear slightly stenotic. On post contrast T1 images, there are diffuse leptomeningeal enhancements which suggest leptomeningitis. No midline shift is appreciated.
1. Diffuse leptomeningeal meningeal enhancement is compatible with meningitis.2. Acute ischemic infarctions involving the body/splenium of the corpus callosum.3. Hemorrhages involving the corpus callosum with intraventricular extension is likely related to hemorrhagic transformation of corpus callosum infarct.4. Segmental, diffuse intracranial (intradural) arterial luminal narrowings without wall thickening nor evidence of enhancement indicating secondary arterial vasospasm possibly due to leptomeningitis or RCVS. Possibility of vasculitis is considered less likely. Follow-up MRI with vascular wall imaging sequence is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.