Brain and neck magnetic resonance imaging from a patient with Exserohilum meningitis and stroke

Axial diffusion-weighted imaging from hospital days 4 (A) and 7 (B) shows progression of pontine infarction (arrows). Axial T2-weighted fluid attenuated inversion recovery imaging from hospital days 4 (C) and 7 (D) similarly shows disease progression as indicated by increasing hyperintensity in the midbrain (arrows) and interval development of ventriculomegaly secondary to brain stem edema (asterisks). Additional infarctions with comparable evolution were located in the medulla and cerebellar hemispheres (not shown). Coronal T1 imaging after the administration of intravenous gadolinium on hospital day 7 (E) shows diffuse leptomeningeal enhancement (arrows) and ventriculomegaly (asterisks). Axial T2-weighted short tau inversion recovery imaging (F) and T1-weighted imaging after the administration of intravenous gadolinium (G) of the neck show hyperintensity and abnormal enhancement in cervical paraspinal muscles at the epidural steroid injection site, suggesting subcutaneous edema and possible infected fluid collection (arrows).