PMC5439181_01
Maximum lip-to-lip mouth opening size of 12 mm on admission day 28. The patient was initially unable to speak or chew.
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fig1
With passive opening of the patient's mouth, MMO was less than 20 mm with bilateral firm and spastic masseters, resulting in an inability to speak and difficulty clearing secretions (Figure 1).
Representative MRI images showing infarcts in the right parietal lobe (blue arrow; images (a), (c), (e), and (g)) and left ventral pons (red arrow; images (b), (d), (f), and (h)). The right parietal lesion shows DWI signal change without corresponding ADC changes, consistent with subacute infarct. The left pontine lesion shows both DWI and ADC signal changes suggesting acute infarct. FLAIR, fluid-attenuated inversion recovery. DWI, diffusion weighted imaging. ADC, apparent diffusion coefficient. T1 POST GAD, T1 postgadolinium.
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fig2
Gadolinium infused magnetic resonance imaging (MRI) of the spine and brain showed increased signal attenuation in the central pons, left ventral pons, and white matter of the frontal and parietal lobes bilaterally in addition to leptomeningeal enhancement (Figure 2).