PMC6512015_01
Axial noncontrast CT Head (a) and postcontrast T1 (b) MR images at the time of admission. Isodense basal leptomeningitis (arrow) on CT (a) with corresponding thick enhancement (arrows) on MRI (b). Hydrocephalus with dilated temporal horns (t). Incidental arachnoid cyst (A).
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Follow-up computer tomography (CT) and MRI performed 2 weeks later showed hydrocephalus and basal meningeal disease with a pattern of cystic nodular enhancement (Figures 1 and 2) highly suggestive of TBM.
Axial FSE T2 (a) and postcontrast T1 (b and c) images at about 2 weeks of admission. T2 hypointense (a) nodular basal leptomeningeal lesions (arrows) with rim enhancement (b and c). Incidental arachnoid cyst (A).
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Follow-up computer tomography (CT) and MRI performed 2 weeks later showed hydrocephalus and basal meningeal disease with a pattern of cystic nodular enhancement (Figures 1 and 2) highly suggestive of TBM.
Sagittal FSE T2 (a) and postcontrast T1 (b) MR images of thoracolumbar spine at about 3 months of first admission. Spinal cord edema (Arrow 1). Diffuse nodular leptomeningeal and dural disease with ring enhancing abscesses (Arrow 2).
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The MRI of the spine showed progressive diffuse dural thickening and enhancement with intradural thick-walled abscesses causing cord compression and edema (Figure 3).
Axial (a) and coronal (b) noncontrast CT reformatted images at about 9 months after ventriculoperitoneal shunt placement. Large thick-walled abdominal pseudocyst with smooth walls. Note VP shunt catheter within the base of the cyst (arrow, b).
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Approximately 6 months later, he presented with shunt dysfunction and an enlarging abdominal cystic mass related to the tip of the VPS catheter revealed by CT of the abdomen (Figure 4).