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  • study comprises transverse T1-weighted images pre- and post-gadolinium, T2-weighted images and FLAIR images, and sagittal T2-weighted image
  • diffuse thickening of the pachymeninges over the entire cerebrum, most marked on the left
  • lesion is hyperintense in T2-weighted images; marked enhancement after gadolinium administration
  • herniation of the cerebellum
  • signal intensity of muscles appears normal despite history of atrophy
  • diffuse meningeal lesion suggests meningitis as the principal differential diagnosis; diffuse meningeal neoplasia is less likely
  • cerebellar herniation is evidence of increased intracranial pressure
  • MR lesions are compatible with signs
  • CSF analysis is indicated as a means of confirming diagnosis; however, increased intracranial pressure is a contraindication to puncture of cerebellomedullary cistern; a lumbar puncture should be considered instead