case_images: PMC11420026_01
case_images: (A) Brain MRI showing a slight T2-FLAIR hyperintensity of the cortical gyri in the fronto-parietal area at the vertex, in the parasagittal area, with obliteration of the sulci. Comparing T1 sequences (B) and contrast-enhanced T1 sequences (D-F), there is a noticeable pathological pachymeningeal and leptomeningeal enhancement along the profile of the cerebral falx, especially in the posterior region, further confirmed by PET/MRI (C). In addition, a diffuse slight dural meningeal thickening was also reported. Follow-up brain MRI 4 weeks later shows significant improvement of the meningeal enhancement (E', F'). The total body PET/MRI confirmed the cortical hypermetabolism along the falx cerebri, showing also a slightly hypometabolic left parietal cortex (E). Flowcytometry analysis of CSF-infiltrating cells revealed both CD4+ and CD8+ T-cells (I) with an increased ratio (4.5), as well as a small percentage of B cells (6%, (J)), with normal physical parameters (K).
case_images: fimmu-15-1432360-g001.jpg
case_images: PMC11420026_01_fimmu-15-1432360-g001.jpg
case_images: f1
case_images: Neurological examination was normal, while a brain CT scan revealed a slight disappearance of parafalcial cortical sulci bilaterally, confirmed by a high field (3T) magnetic resonance imaging (MRI) scan ( Figure 1 ). In addition, a high field (3T) positron emission tomography (PET)/MRI confirmed the cortical hypermetabolism along the falx cerebri ( Figure 1E ).