 There are multiple small foci of restricted diffusion within the pons with surrounding associated T2/FLAIR signal abnormality consistent with edema. Some of these foci demonstrate peripheral enhancement on post-contrast imaging. The restricted diffusion is suspected to represent purulent material within abscesses. The relatively largest in the right pons measures 4 mm with associated susceptibility artifact consistent with microhemorrhage. A subtle additional extra-axial focus of diffusion hyperintensity noted adjacent to the left superior parietal lobule with enhancement possibly represents an arachnoid granulation. Foci of T2/FLAIR signal abnormality are noted within the bilateral cerebral peduncles which are likely reflective of edema. An additional focus of T2/Flair signal abnormality within the left external capsule is non-specific. There is no leptomeningeal or pachymeningeal enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections. The paranasal sinuses and mastoid air cells are clear.
1. Multiple foci of peripheral enhancement in the pons with diffusion restriction and surrounding edema which are suspected to represent infection with small abscesses. Pyogenic and atypical organisms/etiologies including Listeria should be considered. HSV may also involve this region although less common. 2. No evidence of intracranial mass effect.Findings communicated via telephone by Dr. Grebenciucova to Dr. Staisch at the time of this report on 1/12/2016.