PMC10246599_01
Magnetic Resonance Imaging immediately after the acute onset of quadrivbplegia: a, b: T2/FLAIR sequence, axial view, multiple lesions of high MR signal located in white matter, more intense in bilateral frontal and parietal lobes, as well as in the left temporal and occipital cortex (white arrows), corpus callosum, and the left cerebellum. c, d: DWI/ADC map, axiall view: Lesions with restriction in diffusion sequences in bilateral frontal and left parietal lobes (grey arrows). e, f: T1 after intravenous administration of paramagnetic contrast. Abnormal enhancement of the meninges (black arrow).
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Lesions were characterized by a hyperintense signal in T2/FLAIR sequence, along with restricted diffusion, as shown in Figure 1.
Computed Tomography with intravenous contrast: Multiple hypodense areas in the frontal and parietal lobes (black arrows - a) and in the left temporal and occipital lobe (black arrows - c). Leptomeningeal enhancement is demonstrated (grey arrow - b and d).
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A Computed Tomography (CT) scan of the brain, cervix, and thorax combined with pulmonary angiogram protocol was performed right after, which besides the MRI brain findings, also demonstrated filling defects within branches of the pulmonary artery supplying the upper part of the right lower lobe, as well as the lingula on the left side, as shown in Figures 2 and 3.
Pulmonary embolism: Computed tomography image with pulmonary embolism protocol: filling defect (white arrow) within branches of the pulmonary artery supplying the upper part of the right lower lobe.
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A Computed Tomography (CT) scan of the brain, cervix, and thorax combined with pulmonary angiogram protocol was performed right after, which besides the MRI brain findings, also demonstrated filling defects within branches of the pulmonary artery supplying the upper part of the right lower lobe, as well as the lingula on the left side, as shown in Figures 2 and 3.
Magnetic Resonance Imaging, without intravenous contrast, 7 days later: a: Fluid- attenuated Inversion Recovery (FLAIR) sequence and b: T2 sequence. Increased area of high signal intensity in the periventricular white matter, in comparison to previous MRI study.
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On the MRI performed a week later (Figure 4), the lesions with restricted diffusion were not visible.
Magnetic Resonance Imaging, 21 days later: a: Tau1 contrast images, b: Tau1W (weighted) and c: Susceptibility Weighted Imaging (SWI). Gyriform leptomeningeal enhancement (grey arrows-b), gyriform hyperintensities of the cortex (white arrows-a), and multiple hypointensities, cortical dot-like abnormalities (black arrows-c), indicating CNS infection with signs of recent hemorrhage.
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Brain MRI 21 days later a: Diffusion Weighted Imaging (DWI), b: DWI, c: Apparent Diffusion Coefficient (ADC) map (same level as -a-) and d: ADC map (same level as -b-). Decrease of restriction of diffusion in centra semiovale (white arrows - a and c) and splenium (grey arrow - b and d) in comparison to previous MRI exams.
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