PMC5216157_01
The brain MRI axial sequences obtained on Day 3, Day 24, and 7 months after admission. DWI showed mild hyperintensity in the brainstem and cerebellum (A-D), and a modest hyperintense signal was observed in the affected areas on ADC mapping (E-H). FLAIR-MRI showed extensive hyperintensity of the infratentorial regions (I), not only in the brainstem and cerebellum (I, J) but also in the deep white matter (K, L) including the temporal pole (I; arrows). Neither the cortex nor the subcortical white matter was affected. The FLAIR image also demonstrated enlargement of the third ventricle and the inferior horn of lateral ventricles (J). FLAIR-MRI on Day 24 showed diminished brainstem and cerebellar edemas and resolution of hydrocephalus (M, N). Both the deep and temporal pole white matter abnormalities had also significantly improved (M; arrows, O, P). Follow-up MRI showed further improvement of the white matter signals at 7 months (Q-T).
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Diffusion-weighted images (DWI)-MRI demonstrated mild hyperintensity (Fig. 1A-D), with an increased signal of an apparent diffusion coefficient (ADC) map of the brainstem, cerebellum, and deep white matter (Fig. 1E-H), which indicated vasogenic edema in these regions. Fluid-attenuated inversion recovery (FLAIR)-MRI showed increased signal intensity in the deep white matter including the temporal pole (Fig. 1I, K and L), as well as in the brainstem and cerebellum (Fig. 1I and J), with enlarged third and lateral ventricles (Fig. 1J). FLAIR-MRI on Day 24 showed complete resolution of the vasogenic edema in the brainstem, cerebellum, and the temporal pole (Fig. 1M and N). The diffuse deep white matter abnormalities were significantly diminished (Fig. 1M, O and P) and further improvement of white matter signals was observed at 7 months (Fig. 1Q-T).
PAS-stained (A) and PAM-stained (B) section of the renal biopsy specimen on Day 24 showing onion-skin thickening of the renal arteriolar walls. The scale bars indicate 100 microm. PAS: periodic acid-Schiff, PAM: periodic acid-methenamine silver
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Renal biopsy revealed onion-skin thickening of the renal arteriolar walls (Fig. 2), which was consistent with the diagnosis of acute hypertensive nephrosclerosis.