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Click 4 y.o male donor with Balamuthia mandrillaris meningoencephalitis. Post contrast T1W axial MRI demonstrating multiple ill-defined areas of enhancement involving the left frontoparietal lobe, left occipital lobe, medial right temporal lobe, and right occipital lobe adjacent to posterior interhemispheric fissure. The most prominent lesions demonstrate a ring-type enhancement pattern. The enhancement primarily involves the cerebral cortices with minimal amount of adjacent leptomeningeal enhancement.

Click 4 y.o male donor with Balamuthia mandrillaris meningoencephalitis. Noncontrasted T1W axial MRI demonstates areas of cortical T1 shortening in the posterior left frontal lobe and bilteral occipital lobes which is suggestive of either cortical/laminar necrosis or developing hemorrhage.

Click 4 y.o male donor with Balamuthia mandrillaris meningoencephalitis. A nonenhanced computed tomography scan of the donor brain at reveals diffuse subarachnoid hemorrhage with effacement of the basal cisterns and evidence of cerebellar tonsil herniation. Increased attenuation was present within the cortex and subcortical white matter in the left frontoparietal and occipital lobes corresponding to the parenchymal signal abnormalities seen on MRI, confirming the suspicion of hemorrhage.

Click Postcontrast T1W axial brain MRI of a 31y.o. kidney transplant recipient demonstrating multiple enhancing lesions involving the bilateral frontal, parietal, occipital, and posterior temporal lobes. There are also enhancing lesions in the central inferior pons, the cerebellar vermis on the right, and left cerebellar hemisphere. Most of these lesions are peripheral or ring enhancing with poorly defined margins. Some enhancement extends to involve the adjacent leptomeninges, particularly at the right sylvian fissure

Click 4 y.o male donor with Balamuthia mandrillaris meningoencephalitis. T2W axial brain MRI of the 31 y.o. female kidney transplant recipient demonstrates parenchymal edema surrounding the lesions in the bilateral frontal, parietal, and occipital lobes as well as within the right thalamus, pons, right cerebellar vermis, and left cerebellar hemisphere. Many of these lesions contain central low T2 signal.

Click 4 y.o male donor with Balamuthia mandrillaris meningoencephalitis. Gradient echo axial brain MRI of the 31 y.o female kidney transplant recipient demonstrates central blooming artifact within multiple lesions in the right cerebral hemisphere, cerebellar vermis on the right, and left cerebellar hemisphere which correspond to abnormal foci of enhancement on pontcontrast images. These findings are highly suspicious for development of central hemorrhage within the enhancing lesions.

Click 4 y.o male donor with Balamuthia mandrillaris meningoencephalitis. Axial Diffusion weighted images of the 31 y.o female kidney recipientís brain demonstrate mildly restricted diffusion primarily along the periphery of multiple lesions in the right frontoparietal and bilateral occipital lobes as well as the cerebellar vermis on the right and right thalamus.

Click 4 y.o male donor with Balamuthia mandrillaris meningoencephalitis. T1W postcontrast axial brain MRI of a 27yo male kidney transplant recipient demonstates multiple ring enhancing lesions involving the right cerebellar hemisphere and right parietal lobes. More solid enhancing lesions are present in the right parietal lobe and distal body/tail of the left hippocampus. Leptomeningeal enhancement adjacent to the right cerebellar lesion was present on prior exams, but not well demonstrated on this exam.