PMC7456943_01
Images of the first MRI study performed at presentation. (A) Mid-sagittal T2W, (B) dorsal T2W, (C) transverse, T2W, (D) T1W pre-contrast, (E) transverse T1W post-contrast. The transverse images are at the level of the nucleus caudatus, and the dorsal image is a slice taken just dorsal to the corpus callosum. The arrow in (A) points to the caudo-ventral aspect of the cerebellum, which is displaced caudally and is partially herniating through the foramen magnum. In (B), notice the blurring of the cerebral sulci, indicating increased brain volume, and the diffuse increased signal intensity of the white matter, which is also seen in (C). The signal intensity changes of white matter are barely perceptible in T1W (D,E) shows a lack of contrast enhancement.
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F1
The MRI revealed bilateral and symmetrical intra-axial and diffuse/ill-defined lesions predominantly affecting white matter, extending from the frontal to the occipital area (Figure 1).
Images of the second MRI study after the resolution of the clinical signs. The transverse and dorsal images are at similar levels as those in Figure 1. (A) Mid-sagittal T2W, (B) dorsal T2W, (C) transverse, T2W, (D) T1W pre-contrast, (E) transverse T1W post-contrast. Notice that the cerebellum shows normal position (A), the cerebral sulci are well-delineated (B), and the white and gray matter show good definition with normal signal intensity in all sequences.
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F2
A brain MRI was performed at the 8-weeks follow-up, revealing a complete resolution of the changes described previously (Figure 2).