Clinical question: Evaluate for meningitis an edematous lesion in pons seen on the outside hospital MRI. LP was performed prior to this exam. Signs and symptoms: Meningitis slight symptoms with edema in pons and an outside MRI. Nonenhanced brain MRI:This examination is performed without the benefit of intravenous contrast as patient refused contrast administration.Examination demonstrates a large ill-defined focus of flair/T2 hyperintensity extensively involving the pons and extending into the medulla and superiorly into the midbrain. The finding results in subtle expansion/increased volume of the pons. There is also subtle crowding of the central tonsils at the level of foramen magnum which is best appreciated on sagittal sequences. The CSF space at the level of foramen magnum however is not significantly effaced.Lack of IV contrast reduces the sensitivity of the exam for further assessment. The finding is nonspecific however differentials of an inflammatory process such as encephalitis, demyelinating process or a neoplastic cause should be considered.Examination demonstrates no evidence of any additional foci of signal abnormality.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise. Excellent calvarium, orbits, paranasal sinuses and mastoid air cells are unremarkable.Unenhanced cervical spine MRI:This examination is also performed without the benefit of IV contrast as patient refused contrast administration.Examination redemonstrate above detailed finding of the pons and medulla.Additionally there is small focus of T2 hyperintensity within the anterior cervical cord on the right at C3 level, small focus of T2 hyperintensity on the left at C6 which extends inferiorly as an ill-defined focus of T2 hyperintensity to C7 level. There is very subtle expansion of the cord at this level.The signal intensity in the alignment of vertebral column is unremarkable. There is however mild left neural foraminal compromise at C6 -- C7 moderate right neural foraminal compromise at C7 -- T1 levels.
1.Nonenhanced MRI of brain and cervical spine demonstrate a single large focus of T2 hyperintensity in the pons with extension superiorly into the midbrain and inferiorly to medulla and multiple foci of T2 hyperintensity within the cervical cord as detailed. Differential diagnosis of demyelinating disease, inflammatory process or granulomatous disease should be considered.2.Nonenhanced MRI of brain is otherwise unremarkable.3.Nonenhanced MRI of the cervical spine is otherwise unremarkable with the exception of minimal degenerative disease. 