Type:
Educational Exhibit
Keywords:
CNS, Neuroradiology brain, CT, MR, MR-Angiography, Other, Demineralisation-Bone, Oedema, Pathology
Authors:
K. Singh, C. Rushton, S. Singh
DOI:
10.26044/ranzcr2022/R-0116
Imaging findings OR Procedure details
CLINICAL COURSE
We present a pictorial case of a 12-year-old male presenting to the emergency department with a fever and unilateral otalgia, who was diagnosed with a complicated otomastoiditis with dual neuroparenchymal sequelae including both CSVT of the dural sinus and CLOCC of the splenium.
Initial assessment with a contrast enhanced CT were in keeping with an extensive otomastoiditis with complicated skull base osteomyelitis. Furthermore, initial imaging demonstrated an occlusive thrombus of the sigmoid sinus, extending to the right internal jugular vein and transverse sinus.
Further evaluation with dynamic multisequence gadolinium MRI including enhanced intracranial venogram performed on a 3T Magnetom Skyra MRI was performed. Findings were in keeping with skull base osteomyelitis, with territorial irregular dural enhancement involving the right cerebellar hemisphere infratentorial cavity in keeping with meningitis. High B value diffusion weighted imaging demonstrated an intrasubstance well circumscribed 8mm region of diffusion restriction involving the splenium of the corpus callosum in keeping with a CLOCC lesion. The lesion demonstrates minimal T1 hypointense signal, avid T2 hyperintense signal abnormality without susceptibility weighted signal abnormality.
The patient was admitted with a multidisciplinary team approach involving paediatric neurosurgical, otolaryngology head and neck, haematology, and critical care specialists. There was aggressive antiobiotic therapy and multisequential imaging follow up which revealed resolution of the CLOCC lesion on subsequent imaging. There were no long term neurological deficits or clinical abnormalities.