"The classic finding on brain MRI is leptomeningeal enhancement on post-gadolinium images that is characteristically localised to the basal cisterns 4,5, but can also be diffuse 4. This enhancement may also extend inferiorly along the spinal cord 4. Interestingly, these areas of leptomeningeal enhancement may have low signal on T2-weighted imaging, perhaps as a result of accompanying haemosiderin from accompanying subarachnoid bleeding 4."
"Differential diagnosis "
"Coccidioidal meningitis refers to central nervous system involvement of the dimorphic fungus Coccidioides spp., mainly Coccidioides immitis and Coccidioides posadasi."
"These features are in addition to the pulmonary and extra-pulmonary signs and symptoms of coccidioidomycosis. It should be noted that coccidioidal meningitis, being a manifestation of disseminated or extrapulmonary coccidioidomycosis, is an AIDS-defining illness."
"other fungal meningitides e.g. cerebral cryptococcosis, cerebral histoplasmosis, neurocandidiasis "
Expected headings
"Clinical features"
"Differential diagnosis "
"Coccidioidal meningitis has numerous imaging features and complications, including secondary hydrocephalus, vasculitis and associated subarachnoid haemorrhage and deep cerebral infarction, and cerebral or spinal abscesses 4-6. MRI is generally considered to be superior in detecting these features when compared to CT 4-6."
"Accompanying this enhancement may be evidence of vasculitis including subarachnoid haemorrhage around the basal cisterns 4,5, or infarction (see ischaemic stroke for MRI appearances) involving deep perforating artery territories in structures of the brain such as those located in the thalamus, basal ganglia, cerebellum, and brainstem 4,5. Focal leptomeningeal enhancement may be appreciated around the parent artery 4. Cortical infarction can also occur but is considered far less common 4."