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Cranial MRI. (A) A T2-weighted image (TR/TE=3,000.0/80.0 ms). High-intensity plaque lesions are evident in the bilateral cerebral white matter, predominantly on the left side. (B, C) A gadolinium-enhanced T1-weighted image (TR/TE=6.0/2.3 ms). These lesions are enhanced with gadolinium, especially in the perivascular sites (red arrows). No gadolinium enhancement of the meninges was detected. (D, E) A diffusion-weighted imaging (DWI) and an apparent diffusion coefficient (ADC) map (b=1,000 s/mm2, TR/TE=5,000.0/65.0 ms). Both DWI and the ADC map show increased values in the involved areas. (F) A T2-weighted image (TR/TE=3,000.0/100.0 ms) after steroid pulse therapy. The high-intensity lesions of the white matter were significantly reduced. R: right
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Magnetic resonance imaging (MRI) revealed areas of confluent and asymmetrical hyperintensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) in the bilateral cerebral white matter (Fig. 1A). Gadolinium-enhanced MRI of the brain revealed multiple punctate and curvilinear lesions spreading from the deep cerebral region to the subcortical white matter, the pons, and the cerebellar vermis (Fig. 1B and C). Furthermore, both diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps revealed diffuse areas of high-intensity (Fig. 1D and E). Her brain MRI showed the shrinkage of the white matter lesions and the disappearance of the gadolinium-enhanced lesions (Fig. 1F).
The immunohistological characteristics of brain tissue. A brain biopsy showing perivascular inflammation, which was predominantly located within the brain parenchyma. The inflammatory cells were mainly T lymphocytes with a cytotoxic T-cell immunophenotype, expressing CD3 and CD8. No EBV-encoded small RNA (EBER) transcripts were detected byin situ hybridization. Hematoxylin and Eosin staining demonstrated non-caseating granulomas containing lymphocytes, histiocytes, giant cells, and rare eosinophils. Original magnification, 100x.
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In situ hybridization for Epstein-Barr Virus (EBV)-encoded small RNAs (EBERs) was negative (Fig. 2).