PMC7297919_01
Brain magnetic resonance images of the patient. T2-weighted images (A-E) demonstrate bilateral symmetrical hyperintense lesions in periaqueductal regions and around the fourth ventricle, which include superior colliculus (A), ventral tegmental area (B), inferior colliculus (C), and superior cerebellar peduncle (D,E). The abnormal regions revealed more obvious hyperintensity signal on corresponding FLAIR images (F-J), increased signal in the lateral ventricles was found (F,G, arrows). The FLAIR sagittal slice showed apparent hyperintense signal in the periaqueductal gray region (K) and surrounding the fourth ventricle (L), and lesions in the lateral ventricles (M). DWI images also manifest restricted water diffusion adjacent to the fourth ventricle (N,O, arrows).
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F1
Magnetic resonance imaging of the brain (Figure 1) showed symmetric T2 hyperintensities predominantly located within periaqueductal gray matter and periventricular regions of the fourth ventricles.
MRI of the lower thoracic spine showed T2 hyperintense lesions from T7 through T9 (arrow). However, the signal was blurry, and we considered it to be undetermined.
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F2
Thereafter, the spinal cord was evaluated, and MRI of the spine revealed a suspicious enhanced T2-weighted signal at the lower thoracic cord region (Figure 2).