PMC8053472_01
(a) T2-FLAIR-weighted magnetic resonance imaging (MRI) showing ischemic stroke in the right head of the caudate nucleus and anterior limb of the internal capsule, (b) Gadolinium-enhanced T1-weighted MRI with basal arachnoiditis, (c) Gadolinium-enhanced T1-weighted MRI showing asymmetric hydrocephalus (AH) and leptomeningeal enhancement, (d) Gadolinium T1-weighted MRI showing AH and left frontoparietal leptomeningeal enhancement.
SNI-12-119-g001.jpg
PMC8053472_01_SNI-12-119-g001.jpg
F1
Three cases presented asymmetric hydrocephalus (AH) [Figure 1] and abnormalities in the fourth ventricle morphology (cases 2, 4-5).
Imaging findings of the fourth ventricle (FV). (a) Severe dilation of the FV (case 2), (b) moderate dilation of the FV (case 4), (c) absence of FV, tonsillar herniation (case 5 with Chiari II malformation).
SNI-12-119-g002.jpg
PMC8053472_01_SNI-12-119-g002.jpg
F2
Case 2 developed a isolated fourth ventricle (IFV) [Figure 2]. II malformation [Figure 2c]. In control MRI studies, two children presented cerebral vasculitis (case 2-3).
Pathologic findings (a) spherule of Coccidioides immitis (white arrow) in cerebrospinal fluid (CSF) cytology (case 2), (b) cell-block form CSF showing a C. immitis spherule (white arrow) accompanied by a background of lymphocytes (black arrows) (case 5).
SNI-12-119-g003.jpg
PMC8053472_01_SNI-12-119-g003.jpg
F3
CSF cytology was positive in two children [Figure 3]. After a month of hospitalization and multiple shunt replacements, C. immitis was isolated in ventricular CSF [Figure 3a] and treatment with Fluconazole 800 mg/day was started.