PMC9420633_01
MRI obtained on admission demonstrating diffuse confluent symmetric T2 FLAIR hyperintensities in the supratentorial periventricular and deep white matter, sparing the subcortical U fibers, and in bilateral cerebellar hemispheres around the deep nuclei (a-c). A focus of T2 FLAIR hyperintensity is noted in the lateral left thalamus (arrow in (b)). Postcontrast images reveals punctiform and curvilinear enhancement centered in bilateral supratentorial periventricular white matter with a perivascular distribution pattern (arrows in (d)). Foci of faint and curvilinear enhancement (arrow in (f)) were also present in bilateral cerebellar white matter. Small curvilinear enhancement was noted in the lateral left thalamus, likely reflective of a vein or a perivenous process (arrow in (e)).
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fig1
Brain MRI demonstrated diffuse confluent, symmetric T2 FLAIR hyperintensity in the supratentorial periventricular and deep white matter and bilateral cerebellum around the deep cerebellar nuclei (Figures 1(a)-1(c)). Postcontrast images revealed punctiform and curvilinear enhancement, mainly in bilateral cerebral and cerebellar periventricular white matter with a pattern suggestive of perivascular distribution (Figures 1(d)-1(f)).
MRI obtained 10 days after admission demonstrating mild progression in diffuse white matter T2 FLAIR hyperintensity (a-c) with slightly increased involvement of the left lateral thalamus (arrow in (b)). Previously noted punctiform enhancement in the supratentorial periventricular white matter has nearly resolved with minimal residual curvilinear enhancement, possibly vessels (arrows in (d)). Small curvilinear enhancement is again seen in the left thalamus (arrow in (e)). Prior curvilinear enhancement in the cerebellum had resolved with interval development of few new punctiform cerebellar enhancing foci (arrows in (f)).
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fig2
Follow-up imaging obtained 10 days after admission demonstrated mild progression in diffuse white matter T2 FLAIR hyperintense inflammatory process (Figures 2(a)-2(c)) with slightly increased involvement in the left lateral thalamus (Figure 2(b)). Previously noted punctiform enhancement in the supratentorial periventricular white matter had nearly resolved with minimal residual curvilinear enhancement (Figure 2(d)). Prior curvilinear enhancement in the cerebellum had also resolved with interval development of few new punctiform cerebellar enhancing foci (Figure 2(f)).