PMC8353446_01
MRI follow up. (A) March 2018: FLAIR sequences showed a left temporo-parieto-occipital and a right temporal hyperintensity (A1, A2, A3); no gadolinium enhancement (A4, A5). (B) April 2018: FLAIR sequences showed an extension of the white matter (WM) hyperintensity (B1, B2, B3); gradient-echo sequences showed microbleeds (B4, B5). (C) June 2018: FLAIR sequences showed a reduction of the WM alterations (C1, C2, C3); susceptibility-weighted imaging (SWI) sequences confirmed microbleeds (C4, C5). (D) February 2019: FLAIR sequences showed a further reduction of the WM alterations (D1, D2, D3); SWI sequences corroborated microbleeds (D4, D5).
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The brain MRI scan showed a large left temporo-parieto-occipital subcortical and deep white matter hyperintensity (WMH) as well as a small area of WMH in the right inferioromedial temporal lobe on FLAIR sequences (Figure 1A1-A3) with no gadolinium enhancement (Figure 1A4, A5). In April 2018, the MRI revealed an extension of WMH with contralateral involvement, a 4-mm midline shift, and a diffuse venous leptomeningeal stasis (Figure 1B1-B3). Numerous cortical microbleeds were also observed on GRE sequences (Figure 1B4, B5) mostly in bi-temporal regions. The previous MRI performed in March 2018 was revised in light of these findings, and it actually already evidenced an initial formation of bi-temporal microbleeds, less easily visible on FLAIR sequences (Figure 1A3) with their subsequent increase in the month of April (Figure 1B3). C5). Consistently with the first MRI (Figure 1A4, A5), gadolinium-enhanced lesions were never observed on MRIs at any time-point. In February 2019, patient was cognitively normal while the MRI showed a further reduction of WMH (Figure 1D1-D3) with standing microbleeds (Figure 1D4, D5).
Timeline of clinical course and interventions.
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The brain MRI scan showed a large left temporo-parieto-occipital subcortical and deep white matter hyperintensity (WMH) as well as a small area of WMH in the right inferioromedial temporal lobe on FLAIR sequences (Figure 1A1-A3) with no gadolinium enhancement (Figure 1A4, A5). In April 2018, the MRI revealed an extension of WMH with contralateral involvement, a 4-mm midline shift, and a diffuse venous leptomeningeal stasis (Figure 1B1-B3). In February 2019, patient was cognitively normal while the MRI showed a further reduction of WMH (Figure 1D1-D3) with standing microbleeds (Figure 1D4, D5). The timeline of the clinical course and interventions of the patient is summarized in Figure 2.