Teenager with nasal congestion for a week who now has a headache, fever, and has become obtunded

MRI of sinusitis, meningitis, and subdural empyema
Axial (above left and above middle) and coronal (above right) T1 MRI with contrast of the brain shows opacification and rim enhancement of the left ethmoid and frontal sinuses, diffuse enhancement of the left meninges, and subdural fluid collections along the left convexity and falx posteriorly. Axial diffusion weighted (lower left) and ADC (lower right) images show diffuse restriction in the left frontal sinus and parafalcine subdural fluid collections.

The diagnosis was pansinusitis with meningitis and subdural empyema.