A 43-year-old man with decreased consciousness

Teaching NeuroImagesNeurology

Resident and Fellow Section

© 2014 American Academy of Neurology

Vignette

• A 43-year-old man with diffuse large B-cell lymphoma who underwent chemotherapy for 5 months presented subacutely with de-creased level of consciousness.

• No remarkable finding on neurological exami-nation was observed except drowsy mental status.

© 2014 American Academy of Neurology Hyun et al

Imaging

© 2014 American Academy of Neurology Hyun et al

Periventricular restricted diffusion MRI in CMV ventriculitis

• Brain MRI revealed periventricular linear diffusion restriction and subtle contrast enhancement along the both lateral ventricular walls which is a characteristic feature of CMV ventriculitis.1

• Cerebrospinal fluid polymerase chain reaction was positive for CMV.

• Treatment with ganciclovir and foscarnet led to gradual improvement of conscious level for 6 weeks.2

© 2013 American Academy of Neurology Hyun et al