260

FIGURE 260-1

FIGURE 260-2

FIGURE 260-3

FIGURE 260-4

FIGURE 260-5

FINDINGS Figure 260-1. Axial NCCT of the brain through the level of the sylvian fissures. There is effacement of the left sylvian fissure and a perisylvian hypodensity (arrows) which was initially interpreted as ischemic infarct because of the history. Figures 260-2 and 260-3. DWI and ADC map through same level. There is restricted diffusion within the left sylvian fissure (vertical arrow in Figure 260-2) surrounded by a large area of elevated diffusion (transverse arrows in Figure 260-3) consistent with edema. Figure 260-4. Axial FLAIR through the area. There is a left perisylvian sharply marginated hyperintensity (arrows) surrounding the effaced heterogeneous left sylvian fissure. Figure 260-5. Axial post-contrast T1WI through the left sylvian fissure. There is thick leptomeningeal/cortical contrast enhancement (arrows) surrounding the left sylvian fissure. There is left perisylvian hypointensity.

DIFFERENTIAL DIAGNOSIS Ischemic infarct, granulomatous meningitis, meningoencephalitis, astrocytoma.

DIAGNOSIS Cryptococcal meningitis.

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