PMC9836365_01
Coronal MR images of low signal intensity lesion (black arrow) centered in the white matter of the left medial orbitofrontal gyrus on MPRAGE T1-weighted (A), and T2 FLAIR (B) images. Features include lack of enhancement on T1-weighted MRI (not shown), high T2 signal (not shown). The extension of signal abnormality to the left frontal horn (white arrows) mimics the transmantle sign of cortical dysplasia. The cortical gray matter overlying the lesion is intact (double arrowheads) which would not be expected in post-traumatic or post-infarct encephalomalacia.
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MRI performed at NIH presentation (Figure 1A,B) demonstrated a lesion centered in the left orbitofrontal gyrus unchanged from the MRI performed 7 years prior.