Clinical question: Evaluate for encephalitic changes. Signs and symptoms: Nausea, vomiting, intermittent confusion, dizziness, neck pain. Diagnosis of viral meningitis. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates normal anatomical development and morphology of brain parenchyma and great normal signal intensity on all MRI sequences.There is no detectable foci of parenchymal, leptomeningeal or CSF space signal abnormality. There is no detectable abnormal parenchymal or leptomeningeal enhancement. No detectable findings to suggest inflammatory intracranial process.There is mild low positioning of the cerebellar tonsils at the level of foramen magnum however without associated signal abnormality or significant effacement of subarachnoid space. Finding is not consistent with urinary malformation is believed to represent a normal anatomical variation.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray-white matter differentiation.Images through the orbits demonstrate a tiny chronic left lamina papyracea blowout fracture and unremarkable otherwise. The signal void of major intracranial arterial branches are identified.The signal intensity of the calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Evidence of sinusitis more noticeable in maxillary sinuses and including a large retention cyst in the left maxillary sinus measuring approximately at 17 x 34 mm.
1.No acute intracranial process.2.Mild low positioning of cerebellar tonsil representing an anatomical variation and not consistent with Chiari malformation.3.Unremarkable pre and post enhanced brain MRI as detailed.4.Tiny left lamina papyracea chronic blowout fracture and unremarkable orbits otherwise.5.Chronic sinusitis and including a retention cyst in the left maxillary sinus as detailed/measured above.