165

FIGURE 165-1

FIGURE 165-2

FIGURE 165-3

FIGURE 165-4

FIGURE 165-5

FIGURE 165-6

FINDINGS Figures 165-1. Axial MR T2WI through the corona radiata. There are multifocal small hyperintense lesions mainly in the deep white matter of bilateral cerebral hemispheres (arrows). Figure 165-2. Axial post-contrast T1WI through the middle cranial fossae. There is a small left medial temporal focal contrast enhancement (transverse arrow). There is mild leptomeningeal enhancement around the brainstem (vertical arrow). Figure 165-3. Axial non- contrast T1WI through the orbits. There is thickened hypointense left optic nerve and sheath (arrow). Figure 165-4. Axial post-contrast T1WI through the lateral ventricles. There is multifocal leptomeningeal and pachymeningeal enhancement (arrows). Figure 165-5. Coronal post-contrast T1WI with fat suppression of the orbits. The left optic nerve and sheath show enlargement and enhancement (transverse arrow). Figures 165-6. Sagittal post-contrast T1WI, through the foramen magnum. There is thickened contrast-enhancing dural plague (pachymeninges) posteriorly at the craniovertebral junction (arrow) projecting into the cerebrospinal fluid (CSF) space.

DIFFERENTIAL DIAGNOSIS

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