PMC10310951_01
Brain MRI of the patient. (A, B) MRI performed at the initial examination. (A) Axial T2-weighted image reveals periventricular and deep white matter hyperintensities. (B) Diameters of the midbrain, pons, and medulla oblongata (MO) are 14.9 mm, 23.3 mm, and 10.1 mm, respectively, on the midsagittal T1-weighted image. (C) MRI performed after a minor head injury shows no prominent changes. The diameters of the brainstem sections were measured as the anteroposterior distance according to the method proposed by Yoshida et al..
fneur-14-1139047-g0001.jpg
PMC10310951_01_fneur-14-1139047-g0001.jpg
F1
Brain MRI showed periventricular and deep WM signal changes in the FLAIR image with no ventricular enlargement (Evans index = 0.26) (Figure 1A). In the spine MRI, mild atrophy of the MO was suspected; the ratio of the sagittal diameter of the MO to that of the pons was 0.43 (Figure 1B). There were no notable changes in the diameters of the sections of the brainstem, although the diameter of the MO was slightly decreased (Figure 1C).
Cervical spine MRI of the patient at the initial examination. (A) Sagittal T2-weighted image reveals unevenly shaped hydromyelia at the cervicomedullary junction (CMJ). (B, C) Axial T2-weighted images at the level of the rostral medulla oblongata (MO) show normal findings in the absence of signal abnormalities in the pyramids. (D) Axial T2-weighted image at the level of the caudal MO reveals bilaterally symmetric hyperintensities around the central canal, resembling angel wings. (E) Axial T2-weighted image at the level of the CMJ reveals a hydromyelia and signal abnormalities radiating laterally from the central canal. (F) Axial T2-weighted image at the C2 vertebral level shows the cervical cord with normal appearance.
fneur-14-1139047-g0002.jpg
PMC10310951_01_fneur-14-1139047-g0002.jpg
F2
Intriguingly, hydromyelia in the CMJ and signal abnormalities radiating laterally from the central canal in the middle portion of the caudal MO were observed (Figure 2).