PMC4901018_01
37-year-old female with Hashimoto's encephalopathy. Brain MRI performed six months after the onset of symptoms. Axial T2 (A and B) and axial fluid attenuation inversion recovery (FLAIR) (C and D) show symmetric and bilateral areas of abnormal high signal on T2-weighted and FLAIR images involving the mesial temporal lobes, caudate nuclei, and putamina (black arrows). The basal ganglia lesions are minimally hyperintense on T1-weighted images (E). These lesions have fine serpiginous enhancement on T1-weighted postcontrast images (G and H) (white arrows). Additionally, a left midbrain lesion, hyperintense on T2-weighted and FLAIR images (A and C), shows no enhancement after gadolinium administration (F) (small arrows).
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No diffusion-weighted signal abnormality was identified (Fig. 1).
37-year-old female with Hashimoto's encephalopathy. Six-month followup brain MRI. Axial T2 (A and B), axial FLAIR (C and D), axial T1 (E), and axial T1-weighted postcontrast (F, G, and H) weighted images show some improvement with reduction in the extent of the high T2/FLAIR signal lesions in the mesial temporal lobes and basal ganglia, with resolution of gadolinium enhancement. The high T1 precontrast signal in the basal ganglia is now much more evident (E). The left midbrain lesion present in the previous exam is currently not seen.
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T2 signal lesions in the mesial temporal lobes, basal ganglia, and midbrain, and resolution of the gadolinium enhancement. The high T1 precontrast signal in the basal ganglia present in the previous exam was more evident (Fig. 2).