Generalized enlarged lymph nodes [R59.1] / Fever, unspecified [R50.9], Reason for Study: ^Reason: hearing loss, 72y with recurrent AML, cervical LAD, concern for leukemic involvement vs. Infection History: hearing loss, neutropenic fevers, cervical LAD Diffuse bilateral hemispheric dural enhancements are seen without evidence of small ventricle size or evidence of brainstem sagging.There is no evidence of abnormal brain parenchymal enhancement. No evidence of acute ischemic or hemorrhagic lesion.There are multiple high signal intensities on FLAIR imaging especially on the right globus pallidus and the parietal white matter and left cerebellar hemisphere indicating possible chronic lacunar infarcts.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Right mastoid air cells show opacification.There is developmental venous anomaly on the left cerebellar hemisphere.
1. Diffuse bihemispheric dural enhancement without evidence of intracranial hypotension. Differential diagnosis include leptomeningeal carcinomatosis, inflammation/infection such as meningitis, post-lumbar puncture or CSF tapping status.2. No evidence of acute ischemic or hemorrhagic lesion.