PMC8455835_01
MRI, MRA and visuospatial and executing skills of the dominant hand results of a patient with alien hand syndrome. MRI: (A-D) Sagittal T2WI scan, axial T2 FLAIR, DWI, and ADC scans show cytotoxic edema in the left frontal lobe and the body of the corpus callosum. (E,F) MRA shows poor visualization of the pericallosal artery and stenosis of the left middle cerebral artery. The patient failed to recognize spatial structure, known as constructional apraxia (G). ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery; MRA, magnetic resonance angiogram; MRI, magnetic resonance imaging; T2WI, T2-weighted imaging.
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F1
The infarct involved approximately two-thirds of the corpus callosum, as observed on the sagittal T2-weighted image (T2WI) (Figures 1A-D). Magnetic resonance angiography (MRA) revealed poor visualization of the A4 segment of the left anterior cerebral artery (pericallosal artery) and stenosis of the left middle cerebral artery (Figures 1E,F). For example, she could not correctly complete drawing a clock and imitate a square schematic to draw a square (Figure 1G).
Cytotoxic edema and visuospatial and executing skills of the dominant hand of the patient improved in 3 months. MRI: (A,B) Sagittal T2WI scan and axial T2 FLAIR show obvious improvement of cytotoxic edema in the left frontal lobe and the body of the corpus callosum. Encephalomalacia foci and gliocyte hyperplasia can be observed in these areas. (C,D) DWI and ADC scans show no limitation of diffusion. The patient failed to recognize spatial structure; however, she has made some progress after this period of recovery (E). ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging; T2WI, T2-weighted imaging.
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F2
On the return visit of the patient, she still could not correctly identify the stereostructure (Figure 2E). At the same time point, the sagittal T2WI and axial T1 fluid-attenuated inversion recovery (FLAIR) image showed obvious improvement in the cytotoxic edema of both the left frontal lobe and body of the corpus callosum (Figures 2A,B). Diffusion-weighted imaging and apparent diffusion coefficient scans showed no limitations of diffusion (Figures 2C,D). Despite improvement of the lesion in the left splenium of the corpus callosum, the lesions in the left frontal lobe and the body of the corpus callosum were persistent and more remarkable than before (Figure 2A).