FIG 2. 80-year-old man with chronic lymphocytic leukemia presented with disorientation and incontinence.

A, Axial unenhanced CT scan shows a solitary lesion in the right thalamus (large arrow) with surrounding vasogenic edema. Attenuation is slightly increased in the anterolateral aspect of the lesion, indicating petechial hemorrhage (small arrow). Note central hypoattenuation.

B, Corresponding axial contrast-enhanced CT scan shows no appreciable enhancement. The patient died 2 days later.

C, Coronally sectioned brain shows bilateral hemorrhagic necrosis of the thalami (right greater than left) and fornices (arrow). Smaller hemorrhagic foci are present in the corpus callosum.

D, Whole-mount coronal section shows thalamic necrosis bilaterally (asterisks). Hemorrhagic necrosis is present in the fornices (large white arrow). Thrombosis of the internal cerebral veins is present (small white arrows). A Gomori methenamine silver–stained section (not shown) revealed hyphae throughout the internal cerebral vein thrombus and walls and in the necrotic brain parenchyma. This anatomic distribution of lesions and the histologic findings indicate the primary pathophysiology is venous infarction with associated fungal encephalitis. Choroid plexitis is also seen (black arrow) (trichrome, original magnification x1).