Intracranial Meningeal Involvement in Churg-Strauss Syndrome

MR findings in a 54-year-old woman with CSS.

A, Axial T2-weighted image (3500/120/2 [TR/TE/excitations]) shows a hypointense plaquelike lesion (arrows) involving dura of the left cavernous sinus and superior ophthalmic fissure.

B, Axial T1-weighted image (600/15/1) shows that the lesion (arrows) is isointense to brain.

C, Axial contrast-enhanced T1-weighted image (600/15/1) shows abnormal enhancement of the lesion (arrows) around the left cavernous sinus and the superior ophthalmic fissure.

D, Coronal T2-weighted image (3500/120/2) shows hypointense nodules (small arrows) in the bilateral lateral recess of the fourth ventricle. Dilatation of the lateral ventricle is shown (large arrows).

E, Axial contrast-enhanced T1-weighted image (600/15/1) shows enhancing nodular lesions in the fourth ventricle, extending to bilateral lateral recess (arrows).

F, Coronal contrast-enhanced T1-weighted image (600/15/1) shows enhancing nodular lesions (arrows) in the fourth ventricle that extend to the bilateral lateral recess.

G, Axial T2-weighted image (3500/120/2) shows hypointense lesion (arrow) along the anterior falx cerebri.

H, Axial contrast-enhanced T1-weighted image (600/15/1) shows thickened enhancement along the anterior falx cerebri (arrow).

I, Axial contrast-enhanced T1-weighted image (600/15/1), obtained 9 months after treatment with steroids and immunosuppressants, shows reduction of the abnormal enhancing lesions around the left cavernous sinus and superior ophthalmic fissure (arrows).

J, Axial contrast-enhanced image (600/15/1), obtained at the same time as that shown in panel I, shows nodular lesions (arrows) smaller than those at treatment.

K, Axial contrast-enhanced image (600/15/1), obtained at the same time as those shown in panels I and J, shows a decrease in degree of enhancement along the falx cerebri (arrow) and improvement of the hydrocephalus.