PMC10140362_01
Hyperintense lesions at C2-4 level on T2-weighted image of spine MRI (A). Faint high signal intensities at T5-6 level on T2-weighted image of spine MRI (B).
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C2-C4 region ( Figure 1A ). Thoracic spine MRI revealed hyperintense lesion over the T5-6 region on T2 weighted image with contrast enhancement on T1 weighted image ( Figure 1B ).
Hyperintensities involving bilateral subcortical white matter and basal ganglia (A), posterior limb of internal capsule (B), brainstem (C) on T2 fluid attenuated inversion recovery brain MRI, with contrast enhancement on post-contrast T1-weighted images (D-F).
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T1 contrast enhancement over the bilateral subcortical white matter, basal ganglia, brainstem, right parietal lobe, and upper cervical cord ( Figure 2 ).
Multifocal hyperintense lesions involving subcortical white matter of bilateral hemisphere (A), posterior limb of internal capsule and thalamus (B), cerebral peduncle and periventricular white matter of temporal horn (C), pontine and subcortical white matter of left temporo-occipital lobe (D), left middle cerebellar peduncle (E) on T2 fluid attenuated inversion recovery brain MRI, with faint contrast enhancement involving right thalamus on post-contrast T1-weighted image (F).
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Brain MRI revealed multifocal T2-hyperintense lesions, involving the subcortical white matters of bilateral hemispheres, thalamus, cerebral peduncles, brainstem, and left middle cerebellar peduncle, indicating disease progression ( Figure 3 ).
Clinical course from Apr. 2001 to Sep. 2021.
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The timeline of the patient's clinical course is shown in  Figure 4 .