PMC5447704_01
(A) 1.5 T brain magnetic resonance imaging (MRI) performed on day 1 showing a right dorsolateral prefrontal cortex (rDLPFC) hyperintensity on diffusion-weighted imaging with a significant decreased apparent diffusion coefficient (ADC) as compared to the homotopic region in the left hemisphere [difference of 0.039 x 10-3 mm2/s, showing 0.723 in the rDLPFC versus 0.762 in the left DLPFC (x10-3 mm2/s)]; (B) control brain MRI performed on day 9 after the onset of symptoms using the same MRI scanner and identical acquisition parameters revealing normal ADC levels on both DLPFC areas [no significant difference, showing 0.803 in the rDLPFC versus 0.785 in the left DLPFC (x10-3 mm2/s)].
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F1
Right DLPFC hyperintensity on diffusion-weighted imaging was reported with a significant decreased apparent diffusion coefficient (ADC) as compared to the homotopic region [difference of 0.039 x 10-3 mm2/s, showing 0.723 in the rDLPFC versus 0.762 in the left DLPFC (x10-3 mm2/s), see Figure 1]. ADC levels in the rDLPFC [no significant difference, showing 0.803 in the rDLPFC versus 0.785 in the left DLPFC (x10-3 mm2/s), see Figure 1].
(A) Brain 99mTc-hexamethylpropyleneamine oxime single-photon emission computerized tomography (99mTc-HMPAO SPECT) performed 13 days after the onset of symptoms revealing a significant decrease in regional cerebral blood flow (rCBF) within the right dorsolateral prefrontal cortex (see white arrows); (B) a 10-month control 99mTc-HMPAO SPECT showing a complete cancelation of the right frontal rCBF decrease present during the symptoms.
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F2
A brain 99mTc-hexamethylpropyleneamine oxime single-photon emission computerized tomography (99mTc-HMPAO SPECT) performed 13 days after the onset of symptoms revealed a significant decrease in regional cerebral blood flow (rCBF) within the rDLPFC (see Figure 2). At the 3-month follow-up examination, the patient was stabilized on a regimen of mianserin 30 mg od in a complete recovery state, with a regression of the frontal dysfunction and a normalization of all neuropsychological functions. A 10-month control 99mTc-HMPAO SPECT revealed a complete cancelation of the rDLPFC rCBF decrease (see Figure 2).