PMC6522838_01
MRI Brain: Fig. 1A Axial DWI. Restricted diffusion in posterior temporal, parietal, and bilateral occipital lobe cortex. Restricted diffusion in splenium of corpus callosum and bilateral posterior thalami. Fig. 1B Axial DWI. Restricted diffusion in parietal lobe cortex. Fig. 1C Axial T1. Leptomeningeal enhancement.
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A brain MRI under sedation revealed restricted diffusion in the bilateral cortical and subcortical regions of the parietal and posterior temporal lobes, splenium of the corpus callosum, and bilaterally in the posterior thalamus (Fig. 1).
MRI Brain: Fig. 2A Axial T2. T2 hyperintensity persists in splenium of corpus callosum. Fig. 2B Axial DWI. Residual hyperintense signal in splenium of corpus callosum is present, in the absence of ADC map hypointensity. This combination of findings indicates "T2 shine through" effect, which follows the acute phase of cytotoxic edema after approximately 2 weeks. The distinction is important as this pattern reflects chronic injury as opposed to new or ongoing injury. Diffusion weighted hyperintensity associated with the prior restricted diffusion in the cortex has subsided, suggesting "pseudonormalization" after ischemic/infectious insult.
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Previous temporoparietal diffusion hyperintensities also had returned to normal and no new areas of signal abnormalities were identified (Fig. 2).
MRI Brain Axial FLAIR: Hyperintense signal in cortex of bilateral parietal lobes indicates cortical injury, and corresponds to the original location of signal abnormality in cortex.
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Stable abnormal diffusion abnormality within the splenium of the corpus callosum and thalami remained (Fig. 3).