Contrast enhanced FLAIR imaging in ibuprofen induced aseptic meningitis

A 31-year-old woman presented with moderate degree holocranial headache of 6 days duration, with exposure to oral ibuprofen 12 h prior to aggravation of headache. There were no neck stiffness or other signs of meningeal irritation. Routine blood examination including erythrocyte sedimentation rate was normal. MR examination showed subtle leptomeningeal enhancement in the right frontal region on contrast enhanced T1 weighted fat saturated images but the contrast enhanced FLAIR images showed the enhancement better. CSF study was suggestive of aseptic meningitis. Patient improved spontaneously after withdrawal of all medications. Ibuprofen is known to produce aseptic meningitis. Contrast enhanced FLAIR sequence has been used successfully to delineate meningeal pathologies. Its routine use should be encouraged in all suspected cases of meningeal diseases.