Malignant pleural mesothelioma usually has a median survival of only nine months from diagnosis, with death usually due to thoracic disease. This has led to the belief in the past, that mesothelioma rarely has distant metastasis with cerebral metastasis accounting for only three percent. This is a unique case of known malignant mesothelioma with distant haemorrhagic metastasis to the brain. This article reviews the imaging evaluation of patients with suspected intracranial involvement and malignant pleural mesothelioma and describes typical imaging findings of parenchymal brain metastasis on computed tomography and magnetic resonance imaging. The incidence of haemorrhagic brain metastasis and various treatment option have also been briefly discussed.

Acute disseminated encephalomyelitis (ADEM) is a central nervous system demyelinating condition caused by viral or bacterial infections or immunizations. The postulated aetiology is an autoimmune reaction against myelin components; however, the mechanistic details are yet unknown. We present the imaging findings of a patient who passed away due to the manifestations of acute disseminated encephalomyelitis. The patient initially underwent surgical repair for type B aortic dissection. 2 weeks after he had poor GCS and no motor response following multiple attempts at sedation hold in the intensive care unit. On magnetic resonance imaging, haemorrhagic white matter abnormalities were noted throughout the cerebral hemisphere indicative of an inflammatory demyelinating process. Our case emphasizes the challenges involved in evaluating emerging neurological problems following a period of intubation /sedation amongst these patients. In addition, unlike children, 50% of adult patients do not have illness or immunisation as a trigger event for this condition.