1. A 43-year-old man with decreased consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

2. Vignette A 43-year-old man with diffuse large B-cell lymphoma who underwent chemotherapy for 5 months presented subacutely with decreased level of consciousness. No remarkable finding on neurological examination was observed except drowsy mental status. © 2014 American Academy of Neurology Hyun et al

3. Imaging © 2014 American Academy of Neurology Hyun et al

4. Periventricular restricted diffusion MRI in CMV ventriculitis Brain MRI revealed periventricular linear diffusion restriction and subtle contrast enhancement along the both lateral ventricular walls which is a characteristic feature of CMV ventriculitis. 1 Cerebrospinal fluid polymerase chain reaction was positive for CMV. Treatment with ganciclovir and foscarnet led to gradual improvement of conscious level for 6 weeks. 2 © 2013 American Academy of Neurology Hyun et al