Headache, neutropenia, fever, multiple episodes of LP. There are multifocal scattered bihemispheric enhancing nodules.The distribution of enhancing nodules are more likely periventricular white matter as well as appendectomy surface. Especially bilateral lateral ventricles' posterior horn area show linear and nodular enhancements. On the left cerebral hemisphere, there is about 1 cm size and elliptical shaped central high signal intensity lesion with preprocedure low signal intensity rim associated with surrounding edema. The central portion of the lesion does not show restricted diffusion but demonstrate ring enhancement as well as adjacent folia enhancement.Above described findings suggest possibility of diffuse infectious process such as cerebritis including ependymitis, but cannot completely exclude possibility of metastatic lesion. The size of the right lateral ventricle appears to be a bit larger than that of the left side. And the signal intensity of the right lateral ventricle posterior horn is slightly higher than that of the left side, but not definitely show noticeable abnormal signal intensity.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
Multiple linear and nodular enhancing lesions on bilateral white matter and ependymal surfaces as well as left cerebellar lesion with surrounding edema. Diagnostic possibility is infectious process such as cerebritis, ependymitis and cerebellar abscess formation with differential diagnosis of metastatic process.