PMC4876204_01
Findings: unenhanced axial brain CT depicts hyperdense striatum (caudate nucleus and putamen). This finding is better seen using narrow window width and higher center settings.
CRIRA2016-5727138.001.jpg
PMC4876204_01_CRIRA2016-5727138.001.jpg
fig1
Using narrow window width and slightly higher center settings better depicted this finding (Figure 1).
Axial T1-weighted sequence depicts right basal ganglia hyperintensity with unremarkable signal abnormality on axial T2-weighted.
CRIRA2016-5727138.002.jpg
PMC4876204_01_CRIRA2016-5727138.002.jpg
fig2
T1-weighted sequences and fairly normal signal intensity on T2-weighted and FLAIR sequences (Figure 2). The apparent diffusion coefficients (ADCs) were slightly lower in right basal ganglia compared to those on the left side.
ADC map shows slight decreased apparent diffusion coefficient in right basal ganglia. Symmetrical normal ADC values one month later.
CRIRA2016-5727138.003.jpg
PMC4876204_01_CRIRA2016-5727138.003.jpg
fig3
ADC values were symmetrical on both basal ganglia (Figure 3).
Striking increase of T1-weighted signal intensity within right striatum one month after the onset of symptoms. Patient was asymptomatic when this MR study was performed.
CRIRA2016-5727138.004.jpg
PMC4876204_01_CRIRA2016-5727138.004.jpg
fig4
Axial T2 gradient echo sequence shows no signal abnormality within right striatum but some scattered blooming artifacts within left thalami consistent with petechial hemorrhages.
CRIRA2016-5727138.005.jpg
PMC4876204_01_CRIRA2016-5727138.005.jpg
fig5
Both MR studies performed with one month difference did not show any abnormality within right striatum on T2 gradient echo sequences (Figure 5).
Axial minimum intensity projection of susceptibility weighted imaging at 10-month follow-up depicts slightly hypointense signal within right striatum.
CRIRA2016-5727138.006.jpg
PMC4876204_01_CRIRA2016-5727138.006.jpg
fig6
However, a 10-month follow-up MR scan showed hypointensity within right striatum on susceptibility weighted images (SWI) (Figure 6).
4-month and 10-month follow-up MR studies. Sagittal T1 depicts persistent hyperintensity within right striatum (green arrow), whereas a 10-month follow-up MR shows complete regression of signal abnormalities.
CRIRA2016-5727138.007.jpg
PMC4876204_01_CRIRA2016-5727138.007.jpg
fig7
No signs of striatum atrophy were shown (Figure 7).