Category: Neuroradiology, Region: Head-Brain and brain nerves, Plane: Sagittal
A 52-year-old man presented with severe cytomegalovirus pneumonitis and kidney failure, and became comatose. Imaging studies documented reversible bilateral frontal hygromas, frontal lobe pseudoatrophy and fluid accumulation in the posterior cerebral regions related to the compromised blood brain barrier function. As the underlying illness improved and the systemic fluid imbalance was corrected, the cerebral volumes reversed to normal and the altered level of consciousness resolved. We highlight the impact of the systemic inflammatory state on the loss of blood brain barrier competence and the consequent, reversible global intracranial fluid redistribution. The relevance of this case stems on the fact that in the absence of inflammatory findings, pseudoatrophy could be less than easily recognized and fluid related volume changes of the cerebral white matter should be considered when interpreting a scan with a seemingly atrophic brain.