Diagnosed with meningitis following presenting with headache and vomiting. Gait is drifting toward the right side. Assess for focal brain abnormality. There are subtle scattered punctate foci of cortical diffusion restriction, some of which correlate with T2/FLAIR hyperintensity. For example, a focus involving the left hippocampus is seen on axial diffusion image #191, FLAIR images #17. Punctate foci in the paramedian frontal lobes are seen on diffusion image #182. There is no large territorial diffusion restriction or intracranial hemorrhage. There is no abnormal parenchymal or leptomeningeal contrast enhancement. There is no abnormal extra-axial fluid collection. The ventricles and other CSF-containing spaces are normal in size. There is no midline shift or brain herniation. Major intracranial vascular flow voids are preserved, reflecting gross patency.There is no gross orbital abnormality. There is no destructive skull lesion. The mastoid air cells are clear. Very minimal ethmoid sinus mucosal thickening is nonspecific.
1.There is no evidence of intracranial abscess or empyema.2.Subtle, scattered cortical punctate foci of diffusion restriction, some of which demonstrate T2 FLAIR hyperintensity may relate to the known infection. Embolic disease and seizure-related foci are additional possibilities but atypical.