History of Crohn's disease with headache and suspected infliximab-induced lupus like reaction. There are scattered areas of fine leptomeningeal enhancement and T2 hyperintensity, which appears to be vascular in nature, predominantly in the posterior bilateral cerebral hemispheres. There is no evidence of intracranial hemorrhage, mass, abscess, or acute infarct. The brain, brainstem, cerebellum, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Scattered leptomeningeal abnormality vasculature, predominantly in the posterior bilateral cerebral hemispheres, may represent a drug-induced vasculitis, without evidence of acute infarction. A brain MRA may be useful for further evaluation, nevertheless.