PMC7098328_01
Magnetic resonance workup. a Contrast-enhanced transverse fluid-attenuated inversion recovery view showing numerous hyperintense foci within brain parenchyma, i.e. within corpus callosum (dotted arrow), together with strong enhancement of peripheral subarachnoid spaces (arrows) contrasting with normal signal suppression of intraventricular CSF (asterisk). This unusual feature assessed intense meningeal inflammation with subsequent massive leakage of contrast agent molecules within surrounding CSF. b Transverse diffusion-weighted (DW) view in similar slice location as a with b factor at 1,000 mm/s2 showing punctate foci seen on previous images as hyperintense foci of restricted water diffusivity with strongly decreased apparent diffusion coefficient (ADC) values (parametric ADC map not shown). Synchronous DW positivity of all lesions closely matched the synchronous enhancement of all lesions seen on post-contrast T1-weighted views (not shown).
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F1
Brain MRI examination was repeated after 3 days and showed numerous additional punctate lesions involving the corpus callosum, together with abnormal meningeal enhancement and contrast agent leakage in the CSF (Fig. 1).
Fluoroangiography at 1 week (a) and 6 weeks (b). a Segmented arterial occlusions (arrows) on the nasal-inferior branch of the central retinal artery. b Whitish ischemic retinal edema (star) on the inferior part of the macula due to a new episode of arterial occlusion affecting the temporal-inferior branch of the central retinal artery (arrow).
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F2
New retinal branch artery occlusions were documented on fluoroangiography (Fig. 2).