PMC6311835_01
(a) Initial CT scan showing increased diffuse enhancement of right cerebrum as well as ill-defined hypodensity in the posterior right frontal lobe (circle). Slight mass effect is shown upon right lateral ventricle with edema (arrow). (b) MRI brain with gadolinium showing parenchymal and leptomeningeal enhancement over the right frontal and temporal lobes with associated T2/FLAIR signal involving right frontal lobe cortex (arrows), finding suggestive of meningoencephalitis.
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fig1
Computerized tomography of the head revealed a right frontal hypodensity (Figure 1).
Biopsy report.
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Brain magnetic resonance revealed patchy leptomeningeal enhancement involving right frontal and temporal lobes associated with subcortical edema (Figure 2).
(a) Chronic leptomeningitis with giant cells. (b) Chronic leptomeningitis is demonstrated again; in this cut, parenchymal perivascular lymphocytic infiltrates are appreciated.
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fig3
Brain biopsy was obtained and showed microglial activation and gliosis, suggesting no microorganisms grew from brain tissue culture (Figure 3).