PMC6515131_01
Selected axial images from initial MRI (a) Central T2 hyperintensity conforming to gray matter at the level of the conus. (b, c) Patchy areas of increased T2 signal intensity in the bilateral thalami (b) and pontomedullary junction (c) with corresponding enhancement following IV gadolinium contrast administration on T1 weighted series (d).
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This prompted Magnetic Resonance Imaging (MRI) scan of the brain and spine that revealed multiple areas of heterogeneously enhancing T2 hyperintensity in the thalami, dorsal pons, medulla, and spinal cord (Fig. 1).
Selected axial FLAIR images on follow up MRI: Interval development of T2 hyperintensity in the periventricular and subcortical white matter of the bilateral frontal lobes (a) bilateral basal ganglia (b) and stable signal change in the bilateral thalami (c). A mild amount of generalized volume loss is seen at all levels.
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Lesions involving the brainstem had significantly improved (Fig. 2).