PMC8160241_01
Brain MRI findings from the first and second scans. First MRI scan (on day 2): axial FLAIR hyperintensity was seen in the sulci of the bilateral frontal, temporal, and parietal lobes (A-D, arrows). Corresponding meningo-cortical enhancement was also seen on axial T1-weighted postgadolinium-enhanced images (E, arrow). Second MRI scan (on day 7): meningo-cortical lesions on axial FLAIR were mildly regressed, but abnormalities were still observed (F-I, arrows). T1-weighted postgadolinium-enhanced image showed a corresponding meningo-cortical lesion with no enhancement (J).
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F1
T1-weighted post-gadolinium-enhanced images (Figure 1). The patient was considered to have developed a central nervous system (CNS) infection and was given empiric antibiotic and antiviral therapy, but his condition steadily worsened, suggesting that there may be other underlying etiologies (e.g., autoimmune encephalitis or tuberculous meningoencephalitis). The second MRI examination on day 8 demonstrated mildly regressed meningo-cortical lesions, but abnormalities were still observed (Figure 1).
Brain MRI findings from the third and fourth scans. Third MRI scan (on day 22): axial FLAIR showed reduced meningo-cortical lesions that were still clearly observable (K-O, arrows). Fourth MRI scan (on day 37): axial FLAIR showed that the meningo-cortical lesions were further resolved (P and Q, arrows), but new lesions were present in the right parietal cortex and right cerebellar dentate nucleus (R and S, arrows). T1-weighted postgadolinium-enhanced image showing left optic nerve thickening and obvious enhancement (T, arrow).
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F2
After further observation, the third MRI examination conducted on day 24 showed that the meningo-cortical lesions had decreased but were still clearly observable (Figure 2). A fourth MRI examination was immediately conducted and showed that the meningo-cortical lesions were reduced compared, but new lesions were present in the right parietal lobe, right cerebellar dentate nucleus, and left optic nerve (Figure 2).
Brain MRI findings from the fifth and sixth MRI scans. Fifth MRI scan (on day 132): axial FLAIR showed persistent meningo-cortical hyperintensity (Y, arrows) and new lesions around the temporal lobe, posterior limb of internal capsule (right), and left trigone of the lateral ventricle (U-X). Sixth MRI scan (on day 148): axial FLAIR showed substantial reductions in the original lesions without new lesion formation (Z, AA, BB, and CC), and the meningo-cortical FLAIR hyperintensity disappeared (DD).
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F3
A fifth MRI examination showed that the original lesions were diminished, but new lesions had developed around the deep white matter (Figure 3). The sixth and final MRI examination was conducted on January 8, 2021 and showed substantial reductions in the original lesions without new lesion formation (Figure 3).