case_images: PMC5498772_01
case_images: Neurological examination. (A,B,C): Major neurological examination included depression, left circling with right head tilt. (D): Ventromedial positional strabismus on the right eye. (E,F): decreased postural reactions on the left side. Neurological abnormalities suggested a multifocal encephalic neuroanatomic localization with right forebrain and central vestibular system involvement.
case_images: OpenVetJ-7-197-g001.jpg
case_images: PMC5498772_01_OpenVetJ-7-197-g001.jpg
case_images: F1
case_images: Ventromedial positional strabismus was the most reliable abnormality detectable on cranial nerves examination (Fig. 1).
case_images: First MRI of the brain. (A): midsagittal and (B): right parasagittal T2-weighted MRI images. (C): Transverse T2-weighted, (D): T1-weighted, (E): FLAIR and (F): contrast-enhanced T1-weighted MRI images obtained at the level of the rostral midbrain. T2W ad FLAIR images show a sharply hyperintense well demarcated lesion affecting the ventrolateral portion of mesencephalic tegmentum (arrows) and adjacent caudo-ventro-lateral portion of the right thalamus (not shown). The lesion extends to the medial surface of the right temporal lobe with involvement of cerebral cortex of the parahippocampal gyrus and ventral portion of right hippocampus (arrowheads). The lesion appears isointense on T1-W images with faint and irregular enhancement after contrast medium administration. No mass effect is evident.
case_images: OpenVetJ-7-197-g002.jpg
case_images: PMC5498772_01_OpenVetJ-7-197-g002.jpg
case_images: F2
case_images: The lesion appeared isointense on T1-W images with mild and irregular enhancement after contrast medium administration (Fig. 2).
case_images: First MRI of the brain. (A): Transverse T2-weighted and (B): FLAIR MRI images obtained at the level of the caudal thalamus. The mesencephalic lesion extended cranially with focal involvement of the caudo-ventro-lateral portion of the right thalamus (arrows). In the temporal lobe signal changes involved both gray and white matter of the parahippocampal gyrus. (C): Oblique-transverse FLAIR image at level of cross reference in image (D), showing in detail the mesencephalic and telencephalic lesion extension (thin arrow).
case_images: OpenVetJ-7-197-g003.jpg
case_images: PMC5498772_01_OpenVetJ-7-197-g003.jpg
case_images: F3
case_images: Repeat MRI of the brain acquired 30 days after the first examination. (A): Transverse T2-weighted, (B): T1-weighted, (C): FLAIR and (D): contrast-enhanced T1-weighted MRI images obtained at the level of the rostral midbrain. There is significant reduction in size of the primary lesions and fluid replacement of T2 and FLAIR hyperintense mesencephalic areas previously detected (arrows). (E): Transverse T2-weighted and (F): FLAIR MRI images obtained at the level of the caudal thalamus showing normal parenchymal signal intensity of the thalamic area previously involved by the lesion. Slight residual hyperintensity is observed at the level of parahippocampal gyrus (arrowheads) with fluid signal at the level of the ventral portion of right hippocampus (thin arrows).
case_images: OpenVetJ-7-197-g004.jpg
case_images: PMC5498772_01_OpenVetJ-7-197-g004.jpg
case_images: F4
case_images: The second imaging examination showed significant reduction in size of the primary lesions and fluid replacement of T2 and FLAIR hyperintense mesencephalic areas previously detected (Fig. 4).