PMC9699861_01
Brain magnetic resonance imaging (MRI) of the patient at presentation (a-d) axial cuts of T2-weighted image of brain MRI of index patient showing multiple hyperintense lesions largest in the right capsuloganglionic area and adjacent white matter displaying concentric rings/bars (a-c). (d) Shows a similar hyperintense lesion in the left cerebellar hemisphere (white arrow depicts the lesion).
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F1
T1WI [Figure 1]. The T2WI [Figures 1a-c and  2a-f] images showed similar isointense and hyperintense lamellae with a patchy enhancement pattern on the administration of gadolinium contrast [Figures 2g and h]. Similar lesions of varying intensities were noted in the right frontal, left occipital, and left cerebellar regions [Figures 1c-d and 2e-f].
Brain MRI of index patient before treatment (a-h): Brain MRI showing T2, FLAIR, T2, T1, figures 2a-f and postcontrast images of BCS depicting the alternating concentric lamella of demyelination plaques and punctate contrast enhancement (g and h) Red arrow shows the lesion.
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F2
T1WI [Figure 1]. The T2WI [Figures 1a-c and  2a-f] images showed similar isointense and hyperintense lamellae with a patchy enhancement pattern on the administration of gadolinium contrast [Figures 2g and h]. Similar lesions of varying intensities were noted in the right frontal, left occipital, and left cerebellar regions [Figures 1c-d and 2e-f].
Cervical spine MRI (a and b) shows normal T1WI and T2WI of the cervical spine. Arrow (b) points to brainstem hyperintensity suggestive of demyelinating lesion.
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F3
Cervical MRI was normal [Figures 3a and b].
Brain MRI after two courses of high-dose steroids and immunosuppressive agents (a-d) shows similar cuts in Figure 1 of the same patient 7 months after treatment. Note almost complete resolution of inflammatory plaques.
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F4
Brain MRI repeated 2 months after the second course showed almost complete resolution of the lesions with no associated edema or contrast enhancement [Figures 4 and 5].
Brain MRI patient after treatment (a-h) T2, FLAIR, T2, T1WI, and postcontrast images show almost complete resolution of the inflammatory plaques after treatment with high-dose steroids and immunosuppressive. Compare with findings in Figure 2.
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F5
Brain MRI repeated 2 months after the second course showed almost complete resolution of the lesions with no associated edema or contrast enhancement [Figures 4 and 5].