Assess prepontine cistern for tuberculosis: history of potential TB meningitis, incompletely treated meningitis recently finished therapy. Now persistent headaches and photophobia. There is interval progression of leptomeningeal enhancement along the surface of the pons, along the surface of the medulla, within the basal cisterns, and along the surface of the cerebellum. There is also interval progression of high T2 signal with punctate foci of enhancement and mild susceptibility effect in the medial left thalamus. There are also scattered punctate foci in the white matter of the bilateral cerebral hemispheres, which are stable to perhaps slightly more conspicuous in some cases. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is redemonstration of an ovoid enhancing lesion in the right frontal calvarium that measures up to 12 mm, without associated soft tissue swelling.
1. Interval progression of leptomeningeal enhancement along the surface of the pons, medulla, basal cisterns, and along the surface of the cerebellum, which may represent tuberculous meningitis.2. Interval progression of high T2 signal with punctate foci of enhancement in the medial left thalamus may represent evolving tuberculous cerebritis. 3. Mild bilateral cerebral white matter hyperintensities are nonspecific.4. A right frontal calvarial lesion is nonspecific, but may also represent a manifestation of tuberculosis versus an atypical hemangioma.