PMC6307248_01
Timetable
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Fig1
At first, a Cerebrovascular accident (CVA) was suspected, so treatment with carbasalate calcium 80 mg once a day was started, see timeline (Fig. 1).
MRI cerebrum Fluid Attenuated Inversion Recovery (FLAIR), diffuse white matter lesions with extension into the pons and medulla oblongata
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Fig2
However diffuse white matter lesions around the fourth ventricle with extension into the pons and medulla oblongata were seen (Fig. 2).
MRI cerebrum (T1), diffuse hyperintensity and swelling, with enhanced ring shaped areas
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Fig3
A new MRI showed diffuse hyperintensity and swelling of the basal ganglia, with enhanced ring-shaped areas that indicate necrosis (Fig. 3).
Microscopic findings. Hematoxylin - Eosin coloring, magnification 200x, showing mixed nuclear inflammatory infiltrates as sign of vasculitis of the entire brain with concomitant vascular destruction and trombosis
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Fig4
There were signs of vasculitis in almost the entire brain, with complete destruction of the vessels in the basal ganglia (Fig. 4).
Macroscopic, active vasculitis with diffuse hemorrhagic infarction from the midbrain into the cerebellum
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Fig5
Also the midbrain showed active vasculitis with diffuse hemorrhagic infarction (Fig. 5).