PMC5954568_01
Left/right: Axial (caudal to rostral) CT angiography of the head and neck with iodine contrast, noted for possible diminutive appearance of the distal MCAs (middle cerebral artery) and ACAs (anterior cerebral artery) bilaterally.
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CT angiography of the head and neck with iodine contrast was however noted for question of diminutive appearance of the distal MCA (middle cerebral artery) and ACA (anterior cerebral artery) bilaterally, although the clinical significance of this was initially uncertain (Figure 1).
(a and b) Axial T1-post-contrast gadolinium MRI of the brain, which reveals a 12 mm focus of mass-like enhancement in the pineal region abutting the tectum (green arrow). (c) Sagittal view, with area of post-contrast enhancement around the tectum and occipital lobe.
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Repeat magnetic resonance imaging (MRI) brain with and without gadolinium revealed a new 12 mm focus of mass-like enhancement in the pineal region with adjacent right midbrain T2 signal abnormality and prominent adjacent leptomeningeal enhancement involving parieto-occipital sulci and superior cerebellum (Figure 2).
Left: Sagittal T1 lumbar spine MRI, right: sagittal T1-post contrast, with noted small focus of enhancement among the cauda equina, particularly at the right posterior lateral aspect of the thecal sac at the level of L4.
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A lumbar spine MRI with and without contrast was obtained and revealed small foci of enhancement around the cauda equina (Figure 3).