PMC7641677_01
FLAIR brain MRI showing hyperintensity involving peduncles and middle cerebellar peduncles (a). Head of the caudate nucleus and both globus pallidus (b). Corpus callosum and corona radiata (c, d). Gadolinium T1 sequence (e-h) showing focal pathological enhancement in the right parietal lobe (h).
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A brain MRI showed hyperintensities and extended T2-signal and fluid-attenuated inversion-recovery sequence (FLAIR) involving cerebral peduncles and middle cerebellar peduncles, parietal corpus callosum, and corona radiata (Figures 1(a)-1(d)). Furthermore, there was an abnormal focal enhancement in corona radiata of the right parietal lobe (Figures 1(e)-1(h)).
DWI brain MRI showing a hypersignal in the cerebellar hemisphere (a), corpus callosum (b, c), and corona radiata (c). There was a corresponding decrease of ADC values on the ADC map (d-f).
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Short-tau inversion-recovery (STIR) sequence and T2: sagittal and axial slice. (a, b) extensive medullar hyperintensity of the lateral and posterior cords at levels C2-T1.
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Spinal cord MRI showed a longitudinally extensive, nonenhancing STIR-hyperintense lesion from C2-T1 with mild edema (Figures 3(a) and 3(b)).
Histopathology of a biopsied subcortical lesion of the right frontal lobe (hematoxylin and eosin staining). (a) The bottom of the image shows normal eosinophilic white matter and demyelinated tissue at the top. (b) Magnification of demyelination zones with macrophage infiltration.
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A brain biopsy was performed at the 20th day of hospitalization, revealing white matter necrosis, areas of demyelination, and gliosis, as well as macrophage infiltrates and perivascular lymphocytes (Figure 4).