PMC4590553_01
Native initial MRI (2003).. Notes: A mass-like lesion is situated in the right temporal lobe with cystic and infiltrative portions and perifocal vasogenic edema (Native TSE T2 WI transversal scans).. Abbreviations: MRI, magnetic resonance imaging; TSE T2 WI, turbo spin echo T2 weighted images.
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Additionally, a smaller lesion was detected in the hypothalamus (Figures 1 and 2).
Initial post-gadolinium MRI (2003).. Notes: There is nonhomogenous irregular post-gadolinium enhancement in the mass-like lesion. Also, enhancing infiltration in the hypothalamus is clearly depicted. (SE T1 WI after gadolinium enhancement, transversal).. Abbreviations: MRI, magnetic resonance imaging; SE T1 WI, spin echo T1 weighted images.
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Additionally, a smaller lesion was detected in the hypothalamus (Figures 1 and 2).
MRI at time of neurological onset 1 (2005).. Notes: A small round lesion is situated in the right thalamus with tiny dot-like central post-gadolinium enhancement (arrow). (Native TSE T2 WI, transversal; post-gadolinium SE T1 WI, coronal).. Abbreviations: MRI, magnetic resonance imaging; SE T1 WI, spin echo T1 weighted images; TSE T2 WI, turbo spin echo T2 weighted images.
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One small lesion was situated in the right thalamus with discrete, central postgadolinium enhancement (Figure 3).
MRI at time of neurological onset 2 (2005).. Notes: The infiltrative lesion is situated around the cerebral aqueduct in the mesencephalon. Only very discrete dot-like enhancement is apparent after gadolinium administration (arrow). (Native FLAIR and post-gadolinium SE T1 WI, transversal).. Abbreviations: MRI, magnetic resonance imaging; FLAIR, fluid attenuation inversion recovery; SE T1 WI, spin echo T1 weighted images.
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The second new lesion had an infiltrative appearance and surrounded the cerebral aqueduct in the mesencephalon; discrete dot-like enhancement was also apparent (Figure 4).
MRI at time of neurological progression 1 (2006).. Notes: A new mass-like lesion situated in the brain stem primary affecting the pons. (TSE T2 WI, transversal).. Abbreviations: MRI, magnetic resonance imaging; TSE T2 WI, turbo spin echo T2 weighted images.
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Brain MRI showed a new mass-like lesion in the brain stem with small ring-like, central, postgadolinium enhancement (Figures 5 and 6).
MRI at time of neurological progression 2 (2006).. Notes: Small ring-like post-gadolinium enhancement in the brain stem lesion also depicted in Figure 5. (Post-gadolinium SE T1 WI, transversal and sagittal).. Abbreviations: MRI, magnetic resonance imaging; SE T1 WI, spin echo T1 weighted images.
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Brain MRI showed a new mass-like lesion in the brain stem with small ring-like, central, postgadolinium enhancement (Figures 5 and 6).
Last MRI (2015).. Notes: On the last MRI, diffuse brain atrophy and severe hippocampal atrophy/sclerosis were found. (TSE T2 WI, coronal).. Abbreviations: MRI, magnetic resonance imaging; TSE T2 WI, turbo spin echo T2 weighted images.
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MRI showed diffuse brain atrophy and severe atrophy of the right hippocampus with hippocampal sclerosis (Figure 7).