Headache, malignancy, vomiting... pay attention to the differential diagnosis

*For medical professionals' reference only, can you tell at a glance.
A 42-year-old immunocompromised man with headache, nausea, and vomiting
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Look at the image below, what do you consider the patient’s diagnosis? ---Answer dividing line---Are you sure you want to see the answer? ▌ The axial MRI FLAIR image (a) of image analysis shows that the occipital horns of the ventricles, the ependymal surface, the deep gray matter and the white matter of the brain are hyperintensive
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Axial MRI T1 enhanced image (b) shows that the symmetry of the posterior ependyma of the bilateral ventricles is abnormally enhanced, and the brain volume is reduced disproportionately to age
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▌ Imaging diagnosis of ventriculitis
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▌ Clinical manifestations A.
Ventricle or ependymitis can be caused by blood dissemination or direct spread of inflammation of brain parenchyma, such as ventricular abscess breaking into the ventricle
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B.
People with impaired immune system or ventricular drainage tube implantation are more likely to develop intraventricular infection
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Cytomegalovirus, Toxoplasma gondii and tuberculosis are common causes of infection in patients with compromised immune systems
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C.
In the MRI T2/FLAIR sequence, ventriculitis is manifested as a significant thin layer of ependymal enhancement, running along the edge of the ventricle
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Layered debris deposits are more common in the ventricle, which manifests as limited diffusion in the case of purulent infection
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The long-term and short-term complications of ventriculitis include hydrocephalus, which is more common in traffic; dilation around the ventricle may be caused by poisoning or ischemic brain damage
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 ▌ Image identification A.
Ventritis is more common in immunosuppressed patients, accompanied by intraventricular enhancement and stratified debris deposition
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B.
Intraventricular hemorrhage is usually caused by reflux of subarachnoid hemorrhage, or secondary to cerebral parenchymal hemorrhage breaking into the ventricle
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C.
Infected debris and blood degradation products can be deposited in layers in the corresponding ventricular system
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D.
Intraventricular tumors are often irregular or nodular enhancement
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References: [1]Smirniotopoulos JG, Murphy FM, Rushing EJ, et al.
Patterns of contrast enhancement in the brain and meninges[J].
Radiographics, 2007, 27(2): 525-551.
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