Case 37 - Subacute BE with ventriculitis and sceptic emboli

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Report

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication: History of intraventricular hemorrhage status post heparinization. Hypertension, hyperlipidemia, alcohol abuse, sepsis with meningitis and endocarditis.

Technique: Sagittal T1 weighted, axial T2 weighted, axial FLAIR, axial diffusion weighted scans, with and without susceptibility weighted sequences were performed through the brain. No immediate complications were noted. ADC maps were constructed from the axial diffusion weighted scans after 3D post-processing from raw data.

Findings:

These images demonstrate a small focus of restricted diffusion along the prefrontal cortex on the right side measuring approximately 6 mm. Additional foci of restricted diffusion are present in the medial aspect of the frontal lobes bilaterally as well as the prefrontal cortex of the left frontal lobe. Additional punctate areas of restricted diffusion are present in the left caudate, periinsular region and occipital lobes. There is high signal intensity material also layering in the lateral ventricles and fourth ventricle, likely purulent material. Small punctate areas of restricted diffusion are also found in the cerebellum.

The FLAIR scans show periventricular white matter high signal intensity as well as ventricular enlargement. There are subinsular high signal intensity as well. Punctate areas of high signal intensity are present in the pons.

Both vertebral arteries, the basilar artery and both carotid arteries are patent.

IMPRESSION:

Multifocal punctate areas of restricted diffusion in multiple vascular distributions likely a manifestation of the patient's known endocarditis with embolic infarctions.

The high signal intensity in the diffusion-weighted scans of the ventricles suggesting purulent material likely from the patient's known meningitis.

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Introduction

Introduction to the Emergency Brain Imaging Course

Clinical Scenario 1

New Neurologic Deficit

CLINICAL SCENARIO 2

Head Trauma Introduction

CLINICAL SCENARIO 3

Worst Headache of Life

CLINICAL SCENARIO 4

Found Down

CLINICAL SCENARIO 5

Fever and Seizure

CLINICAL SCENARIO 6

S/P, VPS, New Lethargy

Case 37 - Subacute BE with ventriculitis and sceptic emboli