PMC5496458_01
(A) A magnetic resonance image with gadolinium enhancement at initial presentation. The image shows a 2.9 cm ring-enhancing lesion in the right basal ganglia with central area of necrosis and extensive surrounding vasogenic edema causing a 7 mm midline shift to the left, effacement of right frontotemporal sulci, and nearly complete effacement of the right lateral ventricle. Mass effect also causes right-sided uncal herniation effacing the ambient cistern. There are two additional enhancing satellite lesions in the left posterior frontal lobe. (B) A magnetic resonance image with gadolinium enhancement 6 weeks after treatment. This is an image of the brain after treatment showing significant decrease in size and interval resolution of peripheral enhancement of a hemorrhagic lesion in the head of the right caudate nucleus. Surrounding vasogenic edema has nearly completely resolved as well. Previously described additional small enhancing lesions in the left cerebral hemisphere are no longer present.
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MRI was repeated which exhibited significant improvement in brain mass and surrounding edema (Fig. 1B).
PMC5496458_02
PMC5496458_03
PMC5496458_04
(A) A magnetic resonance image with gadolinium enhancement at initial presentation. The image shows a 2.9 cm ring-enhancing lesion in the right basal ganglia with central area of necrosis and extensive surrounding vasogenic edema causing a 7 mm midline shift to the left, effacement of right frontotemporal sulci, and nearly complete effacement of the right lateral ventricle. Mass effect also causes right-sided uncal herniation effacing the ambient cistern. There are two additional enhancing satellite lesions in the left posterior frontal lobe. (B) A magnetic resonance image with gadolinium enhancement 6 weeks after treatment. This is an image of the brain after treatment showing significant decrease in size and interval resolution of peripheral enhancement of a hemorrhagic lesion in the head of the right caudate nucleus. Surrounding vasogenic edema has nearly completely resolved as well. Previously described additional small enhancing lesions in the left cerebral hemisphere are no longer present.
gr1.jpg
PMC5496458_04_gr1.jpg
fig0005
MRI was repeated which exhibited significant improvement in brain mass and surrounding edema (Fig. 1B).
Upper GI endoscopy with scattered moderate inflammation characterized by shallow ulcerations was found in the gastric antrum (A) and in the gastric body. The largest lesion was 5 mm in largest dimension (B) which was injected with epinephrine for hemostasis. Biopsies were taken with a cold forceps for histology.
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