Meningitis is a frequent neurological cause of morbidity and mortality worldwide including Indian subcontinent. Among the various etiologies, pyogenic type is the most predominant. Despite clinical diagnosis, imaging is often required to rule out coexisting focal lesions; detection and extent of other complications or when clinical diagnosis is in doubt . In majority of cases, plain or non-contrast computed tomography (NCCT) or contrast-enhanced computed tomography (CECT) brain is the initial and only imaging studies required with latter involving intravenous contrast injection allowing detection of areas with breach in blood brain barrier.
However, in difficult cases magnetic resonance imaging (MRI) brain or contrastenhanced MRI (CEMRI) is preferred as a problem solving tool with latter involving intravenous contrast injection and delineates area of breach in blood brain barrier. This article describes unusual form of pyogenic meningitis associated with septic vasculitis and infarcts where NCCT brain mimicked leukodystrophy and contrast-enhanced MRI (CEMRI) revealed signs of unusual meningitis. In usual form, there may be leptomeningeal enhancement or basilar exudate enhancement but in unusual form which is more severe, meningitis leads to septic vasculitis leading to necrosis of vessel wall and luminal thrombus formation and subsequent infarction.