PMC6875412_01
Initial MRI brain, FLAIR transversal images with multifocal abnormal hyperintensities (arrows). (a) Middle cerebellar peduncle. (b) Periventricular and subcortical white matter, right caudate nucleus, and left lentiform nucleus. (c) Deep white matter.
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MRI FLAIR:sequences presented abnormal but nonspecific bilateral hyper-intensities supra- and infratentorially in the gray and white matter (periventricular and subcortical white matter), the basal ganglia, the thalamus, the middle cerebellar peduncle, and in the brainstem (Figures 1(a)-1(c)).
MRI brain 4 months after presentation. FLAIR transversal images (a and b) and post contrast image (c) demonstrating marked brain atrophy and new abnormal hyperintensities in the spinal cord (arrow, a) and cerebellum (arrowhead, a) , throughout the periventricular and subcortical white matter (b) and new enhancement (arrows, c).
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T2w signal hyperintensities, again supra- and infratentorially and, again, of the gray and white matter. There were new lesions in the upper cervical spinal cord and new small areas of parenchymal enhancement as well as marked brain atrophy, indicating a progressive and prolonged disease process (Figures 2(a)-2(c)).
(a) HE staining of brain biopsy showing a nearly obliterated vessel with perivascular lymphocytes and a giant cell (arrow points ta the giant cell). Scale bar: 100 microm. (b) Immunostaining against Kim1P positive monocytes and monocytic giant cells (arrow points at giant cells, counterstaining of nuclei with hemalum). Scale bar: 100 microm
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