PMC7495514_01
Axial brain MRI images, in fluid attenuated inversion recovery (FLAIR) sequence
showing; (A) Abnormal high signal intensity is noted at the left cerebellar peduncle,
with extension to the left cerebellar hemisphere. (B) Abnormal high signal intensity of
the splenium is seen (arrow). Notice multiple foci of abnormal signal intensities at the
right temporal cortex and bilateral occipital regions.
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An urgent MRI of the brain and spine was scheduled, which showed multiple ill-defined T2/FLAIR hyperintense white matter lesions which were located in the subcortical and deep white matter regions of bilateral centrum semiovale, right frontal, bilateral parietal and occipital regions, splenium of the corpus callosum, left cerebral and cerebellar peduncle with extension to the left cerebellum, as well as the right thalamus (Figure 1). Abnormal high T2/FLAIR signal intensities were also noted in the spinal cord, with long segment involvement from T2 to T5 levels, as well as at the conus medullaris.
Sagittal (A,B) and axial (C) T2 weighted spine MRI images, showing; (A) Long segment
abnormal high signal intensity noted from the level of T2 to T5 vertebra (arrow), with
no obvious cord expansion. (B) Abnormal high signal intensity is seen involving the
conus medullaris, with cord expansion. (C) The abnormal high signal intensity is noted
to be confined centrally (in the gray matter), with sparing of the periphery ("H" sign).
This is at the level of T5 vertebra.
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On the axial images, these were restricted to the central aspect of the cord, with an "H" sign (Figure 2a).