PMC4137046_01
MRI-scan two days after symptom onset. Emerging white matter lesions with slight restricted diffusion but without Gadolinium (Gd) enhancement. A) T1 Gd-enhanced, B) T2-FLAIR (fluid attenuated inversion recovery), C) DWI (diffusion-weighted imaging).
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Fig1
MR imaging of the neuroaxis revealed FLAIR- and T2-hyperintense white matter lesions without gadolinium enhancement and no restrictions in diffusion-weighted sequences (Figure 1), whereas spinal cord was unaffected.
MRI-scan 10 days after symptom onset. Progressive widespread white matter lesions with restriction in diffusion but still unaffected blood-brain-barrier. A) T1 Gd-enhanced, B) T2-FLAIR, C) DWI.
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Fig2
Moreover, metabolic disorders were excluded and virological testing for herpes viral (HSV, VZV, CMV, EBV), influenza, picorna, HIV and JCV infection was unremarkable.Follow-up MRI after 10 days - while the patient remained comatose during interim sedation pauses - revealed a progression of the bilateral white matter lesions and a new slight gadolinium (Gd) enhancement (Figure 2) and MR-spectroscopy showed a reduced N-acetyl-aspartate (NAA) peak.
MRI-scan at 1-year follow-up visit. Markedly reduced white matter lesions. Right occipital hyperintensity on T2 reflects brain biopsy area. A) T2, B) T2-FLAIR, C) DWI.
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Fig3
Correspondingly, upon follow-up MRI, the white matter lesions were markedly reduced (Figure 3).