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PMC6350341_02
FLAIR images (A,C,E,F) T1 post-gadolinium images (B,D,F,G) of the patient at increasing days post-admission (P.A. d) and after administration of IV acyclovir (ACV d). Arrows in A, C, and E demonstrate decreasing FLAIR signal in the left frontal white matter from day 1 to day 17 of acyclovir administration. Double arrows in (B,D,F) demonstrate decreasing left frontal sulcal effacement and increasing size of the left frontal enhancing lesion. Increasing FLAIR signal and increasing size of the enhancing lesion on T1 post-gadolinium of the left frontal lobe are again noted on post-admission day 45 and post-acyclovir day 17 (G,H).
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F1
T2-weighted and FLAIR images (Figures 1A,B). MRIs performed on post-admission days 7 and 14 showed decreased edema but interval increase in the size of the focal enhancing lesion along the left frontal lobe gray matter concerning for glioblastoma (Figures 1C-F). A fourth MRI scan showed increased enhancement of the left frontal lesion (Figures 1G,H).
PMC6350341_03