History of fever, rash, altered mental status. Rule out meningitis. Rule out abscess, edema. No definitive evidence of any area of low attenuation in the brain parenchyma to suggest presence of edema however the ventricular system is very small and slitlike and there is almost no visualization of cortical sulci and several of the cisterns including quadrigeminal cistern and pineal cisterns appear very small. There is also crowding of the cerebellar tonsils at the level of foramen magnum. The findings are concerning for increased intracranial pressure and possible diffuse cerebral edema. There is also suggestion of enhancement of the leptomeninges overlying the cerebellum and the vermis and possibly some in the bilateral frontal and temporal lobes. Further evaluation with an MRI is highly recommended. There is no evidence of any abscess formation or any extra axial fluid collection.The bony density of calvarium remains within normal. Mastoid air cells, middle ear cavities and all visualized paranasal sinuses remain unremarkable.
Findings highly suspicious for meningitis and possible cerebral edema as detailed above. Further evaluation with an MRI is highly recommended.