PNR Head 13

History

12 year old M with altered mental status, fever, headache, elevated WBC

Major Findings

Diffuse sinus disease with air-fluid levels, suggestive of acute sinusitis
Loss of sulci can be due to cerebral swelling or debris (such as pus) within the meninges
Prominence of the temporal horns of the lateral ventricles, which can be a sign of early hydrocephalus

Teaching Points

These findings are nonspecific, however in a patient with fever, headache, and leukocytosis, this constellation of findings is concerning for meningitis. Meningitis can result in debris in the meninges (subarachnoid space) which can fill the sulci and plug subarachnoid granulations, leading to "communicating" hydrocephalus.

Accession: CL0676

Study description: CT HEAD W/O CONTRAST