PMC4899933_01
Coronal contrast-enhanced T1-weighted MRI (A, right side; B, left side) demonstrates nodular leptomeningeal enhancement in the Sylvian fissures in the location of the M1 segments of the middle cerebral arteries (arrows). Diffuse pachymeningeal enhancement is also demonstrated.
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MRI with contrast (Fig. 1) obtained approximately seven months after first presentation demonstrated a nodular mass with meningeal enhancement and parenchymal edema adjacent to the right MCA trifurcation, and a slightly more medial mass adjacent to the left MCA.
MRA time of flight (3D MIP) demonstrates (A) mild narrowing of the left middle cerebral artery and (B) marked narrowing of the right middle cerebral artery trifurcation. These areas of narrowing coincide with the areas of nodular leptomeningeal enhancement on the contrast MRI.
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MRA (Fig. 2) in both vessels at the precise location of the enhancement. Moderate irregularity of the left proximal