PMC9830568_01
Brain and spinal cord MRIs at presentation. (A) Axial FLAIR sequences of first brain MRI at presentation, 3 days after symptom onset, showing subtle non-enhancing ill-demarcated abnormalities in the left middle cerebellar peduncle and the pons. No other abnormalities were identified on this MRI. (B) Axial FLAIR sequences of brain MRI 48 h after presentation, 5 days after symptom onset, showing worsening of abnormalities in the pons, bilateral cerebellar peduncles, and 3 new round white matter abnormalities in bilateral cerebral hemispheres suggestive of inflammatory demyelination with (C) enhancement of one of the lesions in the left parietal lobe on axial T1 sequences with gadolinium. Sagittal and axial T2 sequences of (D) cervical and (E) dorsal cord MRIs showing longitudinally extensive myelitis extending from C1 to T12, mainly confined to the grey matter, with (F) a focal faint nodular enhancement at the C7 level and prominent T1 hypointensity throughout the cord on axial T1 sequences with gadolinium.
10.1177_20552173221148911-fig1.jpg
PMC9830568_01_10.1177_20552173221148911-fig1.jpg
fig1-20552173221148911
Initial brain MRI showed subtle abnormalities in the pons and brainstem (Figure 1A). Repeat brain and spinal cord MRI 48 h after presentation showed several lesions in the brainstem, pons, left middle cerebellar peduncles, supratentorial regions, and longitudinally extensive myelitis (Figure 1B-F).