PMC4860679_01
MRI sequences from admission to the OSH 2 days prior to admission at our hospital. These images demonstrate the cerebellar subacute infarction with no restricted diffusion, but contrast enhancement. These images remained unchanged 2 days later on admission to our hospital. (A) DWI, (B) T2, (C) T1 precontrast, and (D) T1 postcontrast.
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F1
On the second admission, she had a brain MRI with and without contrast that demonstrated several new abnormalities (Figures 1 and 2), another unremarkable prolonged EEG, and a lumbar puncture. The appearance was consistent with a subacute ischemic infarction that was unchanged from the images obtained the week before (Figure 1).
MRI brain FLAIR sequences performed on admission to our hospital (A), 7 days after admission (B), 1 month after discharge (C), and 4 months after discharge (D). These images demonstrate the evolution of the left mesial temporal lobe lesion during admission and improvement 1 month and 4 months after discharge.
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F2
On the second admission, she had a brain MRI with and without contrast that demonstrated several new abnormalities (Figures 1 and 2), another unremarkable prolonged EEG, and a lumbar puncture. There was also T2 hyperintensity on fluid attenuation inversion recovery (FLAIR) sequences in the left hippocampus, which was unchanged when compared to the images obtained 1 week before (Figure 2). Repeat imaging 1 month and 4 months post-hospitalization showed near complete resolution of the mesial temporal lobe lesion (Figure 2).
FDG PET CT scan demonstrating increased FDG uptake in the medial left temporal lobe corresponding to the area of increased FLAIR signal seen on MRI brain.
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F3
A whole body PET scan also demonstrated no evidence of systemic malignancy, but a hypermetabolic area in the left mesial temporal lobe in the region of the hyperintensity seen on T2 FLAIR was present (Figure 3).