PMC5347115_01
PMC5347115_02
Brain MRI at admission (A-F) and 1 month after treatment initiation (G-L). (A,G) Diffusion-weighted imaging and (B,H) apparent diffusion coefficient showing restricted diffusion in the right anterior cerebral artery territory, compatible with a recent ischemic stroke. (C) FLAIR sequence showing postischemic lesions in the anterior territory. (I) Extension of the lesion in FLAIR confirming established lesions in right and left anterior cerebral arteries. (D-F,J-L) Vessel wall imaging with MRI (VWI-MR), black blood MRI [high-resolution (3-T), black-blood fat suppressed pre- and post-contrast T1 weighted images]. (D-F) Concentric contrast enhancements (CEs) suggesting a central nervous system vasculitis (indicated by arrows). (D) CE of a distal branch of the left anterior cerebral artery. (E,F) CE of distal branches of the right middle cerebral artery. (J-L) Retraction of the CE after 1 month of combined antiretroviral treatment.
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F1
Brain MRI indicated restricted diffusion in the right anterior cerebral artery territory, compatible with a recent ischemic lesion, and lacunar lesions in the left temporo-occipital and right superior frontal region (Figure 1). Such atypical stroke pattern led us to perform a VWI-MR that demonstrated multiple vascular wall contrast enhancement (CE), particularly on distal branches of the middle (Figures 1E,F) and anterior cerebral artery (Figure 1D). After the first month, most vessels did not show CE anymore (Figures 1J-L).