PMC8249196_01
Spinal MRI of the first and third attack. (A-C) Cervical (T2-weighted imaging) and thoracic (fat-saturated T2-weighted imaging) spinal MRI of the initial attack revealed multiple T2-hyperintense lesions throughout the spinal cord. Axial fat-saturated T1-weighted imaging with contrast enhancement showed eccentric lesions with patchy enhancement. (D-F) Repeat spinal MRI showed new lesions along the cervical and thoracic cord with resolution or attenuation of previous lesions. No enhancement was seen on axial fat-saturated T1-weighted imaging. Lesions were indicated by white arrowheads. MRI, magnetic resonance imaging.
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T2-hyperintense patchy lesions along the cervical, thoracic, lumbar segments, each extending over one to two vertebral segments. There was mild swelling of the conus medullaris ( Figures 2A-C ). The lesions were characterized by an unclear demarcation, eccentric axial location, and vague enhancement. Repeat spinal MRI revealed co-existence of both new lesions and old lesions along the cervical and thoracic cords ( Figures 2D-F ).
Brain MRI of the second and third attack. (A-C) Brain MRI (fat-saturated T2-weighted fluid attenuated inversion recovery imaging) at the second attack showed ovoid juxtacortical and pontine lesions. (D-F) Repeat MRI (T2-weighted fluid attenuated inversion recovery imaging) at the third attack after steroid cessation showed new lesions adjacent to the left posterior horn of the lateral ventricle and resolution of juxtacortical and pontine lesions. Lesions were indicated by white arrowheads. MRI, magnetic resonance imaging.
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Brain MRI this time showed multiple juxtacortical and brainstem lesions with an ovoid shape ( Figures 3A-C ), which was not present at her initial presentation. Repeat brain MRI showed new lesions adjacent to the posterior horn of the lateral ventricle and resolution of the subcortical and brainstem lesions ( Figures 3D-F ).