PMC5437427_01
Brain magnetic resonance imaging at the time of the second attack, revealing multiple white matter lesions on a fluid-attenuated inversion recovery image (a). Follow-up brain magnetic resonance imaging performed 2 months later, revealing similar multiple white matter lesions on a fluid-attenuated inversion recovery image imaging (b) and a magnetic resonance angiography signal loss in her right extracranial internal carotid artery (c [white arrowhead], d). An echogram of her carotid artery, revealing an occlusion of her right extracranial internal carotid artery (e, white arrows) immediately above its origin with a gradual narrowing of the vessel's internal cavity, suggesting thrombosis as the cause of the internal carotid artery occlusion.
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F1
A second brain MRI revealed multiple white matter lesions on the right hemisphere of her brain (Fig. 1a), while there were no hyperintensity lesions on diffusion-weighted imaging. However, although the clinical presentation of this case had 2 or more attacks and 1 objective clinical lesion, it was controversial if dissemination in space was surely demonstrated (Fig. 1a, b). Two months after the onset of the second attack, MR angiography was performed for the first time and revealed signal loss in her right ICA (Fig. 1c, d). An echogram of her CA revealed an occlusion in her right extracranial ICA immediately above its origin, with a gradual narrowing of the vessel's internal cavity (Fig. 1e), suggesting that a thrombosis was the cause of ICA occlusion.