PMC6467045_01
(A) Case 1. DWI showing restricted diffusion in posterior limb of internal capsule (thin arrow), optic radiation, and splenium of corpus callosum (thick arrow). T1 and T2W/FLAIR image showing delayed myelination and cerebral atrophy with T2 hyperintense signal in involved area. (B) Case 1. DWI with corresponding ADC map showing restricted diffusion in posterior limb of internal capsule (red arrow), optic radiation (thin black arrow), splenium of corpus callosum (blue arrow), and cerebral peduncle (thick black arrow). (C) Case 1. Diffusion-weighted image with corresponding ADC map showing restricted diffusion in posterior limb of internal capsule, optic radiation, splenium of corpus callosum, and cerebral peduncle. T1- and T2-weighted image showing delayed myelination and cerebral atrophy with T2 hyperintense signal in involved area
IJRI-29-99-g001.jpg
PMC6467045_01_IJRI-29-99-g001.jpg
F1
MRI brain (noncontrast) was done which revealed extensive areas of restricted diffusion seen as hyperintensity on diffusion-weighted images (with increasing brightness on higher b-value) and low signal intensity on apparent diffusion coefficient, in bilateral cerebral white matter - in periventricular location extending along pyramidal tracts in bilateral cerebral peduncles [Figures 1A-C, 2, and 3]. There was involvement of central tegmental tracts, posterior limb of internal capsule, splenium of corpus callosum, and pyramidal tracts in brain stem [Figures 1A-C, 2, and 3]. The areas of restricted diffusion revealed T2 and FLAIR hyperintense signal [Figure 1].
Case 1. Diffusion-weighted images showing restricted diffusion in posterior limb of internal capsule (red arrow), splenium of corpus callosum (black arrow), and periventricular white matter (blue arrow)
IJRI-29-99-g002.jpg
PMC6467045_01_IJRI-29-99-g002.jpg
F2
MRI brain (noncontrast) was done which revealed extensive areas of restricted diffusion seen as hyperintensity on diffusion-weighted images (with increasing brightness on higher b-value) and low signal intensity on apparent diffusion coefficient, in bilateral cerebral white matter - in periventricular location extending along pyramidal tracts in bilateral cerebral peduncles [Figures 1A-C, 2, and 3]. There was involvement of central tegmental tracts, posterior limb of internal capsule, splenium of corpus callosum, and pyramidal tracts in brain stem [Figures 1A-C, 2, and 3]. Periventricular cerebellar white matter and middle cerebellar peduncles were also involved [Figure 2].
Case 1. Diffusion-weighted images showing restricted diffusion in brain stem (red arrow), middle cerebellar peduncle (blue arrow), and cerebellar white matter (black arrow)
IJRI-29-99-g003.jpg
PMC6467045_01_IJRI-29-99-g003.jpg
F3
MRI brain (noncontrast) was done which revealed extensive areas of restricted diffusion seen as hyperintensity on diffusion-weighted images (with increasing brightness on higher b-value) and low signal intensity on apparent diffusion coefficient, in bilateral cerebral white matter - in periventricular location extending along pyramidal tracts in bilateral cerebral peduncles [Figures 1A-C, 2, and 3]. There was involvement of central tegmental tracts, posterior limb of internal capsule, splenium of corpus callosum, and pyramidal tracts in brain stem [Figures 1A-C, 2, and 3].
PMC6467045_02
Case 2. Diffusion-weighted images showing restricted diffusion in dorsal mid brain (red arrow), posterior limb of internal capsule (green arrow), and medial temporal gyri and periventricular white matter/optic radiation (blue arrow)
IJRI-29-99-g004.jpg
PMC6467045_02_IJRI-29-99-g004.jpg
F4
Noncontrast MRI brain revealed similar changes in T2 and FLAIR hyperintense signal with restricted diffusion as seen in case 1, but involvement of periventricular cerebral white matter and splenium of corpus callosum was less marked, with noninvolvement of cerebellar white matter [Figures 4 and 5].
Case 2. Diffusion-weighted images showing restricted diffusion in posterior limb of internal capsule (red arrow) and medial occipital gyri and periventricular white matter/optic radiation (black arrow)
IJRI-29-99-g005.jpg
PMC6467045_02_IJRI-29-99-g005.jpg
F5
Noncontrast MRI brain revealed similar changes in T2 and FLAIR hyperintense signal with restricted diffusion as seen in case 1, but involvement of periventricular cerebral white matter and splenium of corpus callosum was less marked, with noninvolvement of cerebellar white matter [Figures 4 and 5].