{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T22:06:48Z","timestamp":1786226808776,"version":"build-2736575974"},"reference-count":8,"publisher":"Radiological Society of North America (RSNA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Radiology"],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:sec><jats:title>History<\/jats:title><jats:p> A 76-year-old female patient with a history of rheumatoid arthritis, Sj\u00f6gren syndrome, and hypertension presented with headache, fever, and dysphagia. The patient was taking prednisone and leflunomide to treat rheumatoid arthritis. The headache was primarily left sided and occasionally radiated to the occipital region. The patient had a high-grade fever spike, with a temperature of 104 \u00b0F (40 \u00b0C). Results of a prior lumbar puncture and temporal artery biopsy from an outside hospital were negative. Findings of a neurologic examination were unremarkable. Oropharyngeal examination for dysphagia revealed minimal pharyngeal motility, with pooling of food in the pharynx, which was thought to be due to cranial nerve dysfunction. Laboratory analysis revealed that, except for anemia, complete blood count parameters were within normal limits. C-reactive protein level (49.7 mg\/L; reference range, 0.0\u20138.0 mg\/L), erythrocyte sedimentation rate (&gt;140 mm\/h with Westergren method; reference range, 0\u201327 mm\/h), and brain-type natriuretic peptide level (145 pg\/mL; reference range, 0\u2013100 pg\/mL) were elevated. Blood and urine cultures were negative. A lumbar puncture was performed, which revealed cloudy cerebrospinal fluid (CSF), with an elevated CSF protein level (78 mg\/dL; reference range, 7.0\u201335.0 mg\/dL) and a low CSF glucose level (37 mg\/dL [2.05 mmol\/L]; reference range, 45\u201370 mg\/dL [2.50\u20133.89 mmol\/L]); otherwise, CSF encephalopathy, an autoimmune panel, and cultures were negative. CT and MRI of the brain with paranasal sinus were performed. Nasal endoscopy-guided drainage of the preclival fluid collection was performed, and biopsy of nasopharyngeal tissue was performed. Fluid culture revealed the growth of Candida albicans, as well as Pseudomonas and Enterobacter aerogenes. The patient received fluconazole, ceftriaxone, vancomycin, and metronidazole. Follow-up MRI was performed after 2 weeks. <\/jats:p><\/jats:sec>","DOI":"10.1148\/radiol.223335","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T21:16:40Z","timestamp":1716931000000},"source":"Crossref","is-referenced-by-count":2,"title":["Case 325: Persistent Craniopharyngeal Canal"],"prefix":"10.1148","volume":"311","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7909-123X","authenticated-orcid":false,"given":"Pokhraj Prakashchandra","family":"Suthar","sequence":"first","affiliation":[{"name":"From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (P.P.S., S.B.); and College of Medicine, University of Oklahoma, Oklahoma City, Okla (M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0447-8629","authenticated-orcid":false,"given":"Murali","family":"Nagarajan","sequence":"additional","affiliation":[{"name":"From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (P.P.S., S.B.); and College of Medicine, University of Oklahoma, Oklahoma City, Okla (M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1866-3833","authenticated-orcid":false,"given":"Sudeep","family":"Bhabad","sequence":"additional","affiliation":[{"name":"From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (P.P.S., S.B.); and College of Medicine, University of Oklahoma, Oklahoma City, Okla (M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1577","reference":[{"issue":"1","key":"r1","first-page":"39","volume":"6","author":"Currarino G","year":"1985","journal-title":"AJNR Am J Neuroradiol"},{"key":"r2","unstructured":"Barkovich AJ, Koch BL, Moore KR. 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