PMC4748806_01
Signs of BBB disruption on MRI and in CSF analysis. Native FLAIR (a), postcontrast FLAIR (b), and postcontrast T1-weighted (c) MRI: postcontrast FLAIR images show a prominent leptomeningeal enhancement with hyperintensity in the sulcal spaces in the absence of any parenchymal lesions; T1-weighted postcontrast images also show a mild leptomeningeal enhancement pattern (enlarged detail on the right).
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F1
T1-weighted postcontrast MRI also showed a slight leptomeningeal enhancement (fig. 1).
Overview of the clinical course with concomitant investigations and therapeutic approaches during 8 weeks of hospitalization and further follow-up. PC FLAIR = Postcontrast FLAIR; FU = follow-up; G = generalized seizure; F = focal seizure.
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F2
The patient complained about a progressive headache intensity with continuous nausea and repeated vomiting (an overview of the clinical course is given in fig. 2).
Signs of BBB disruption in the CSF analysis. The Reibergram (CSF/serum quotient diagram) illustrates the BBB dysfunction at every spinal tap (one red dot represents one CSF analysis). The vertical blue line indicates the age-adapted threshold for the albumin CSF/serum quotient (Q Alb). Dots to the right of the line signal a BBB dysfunction. The horizontal blue line represents the threshold for intrathecal IgG synthesis, which was not found (all dots are below the line).
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F3
Increased blood-brain barrier (BBB) permeability was repeatedly demonstrated as illustrated in the Reibergram (fig. 3).