case_images: PMC4748806_01
case_images: 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).
case_images: crn-0008-0010-g01.jpg
case_images: PMC4748806_01_crn-0008-0010-g01.jpg
case_images: F1
case_images: T1-weighted postcontrast MRI also showed a slight leptomeningeal enhancement (fig. 1).
case_images: 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.
case_images: crn-0008-0010-g02.jpg
case_images: PMC4748806_01_crn-0008-0010-g02.jpg
case_images: F2
case_images: 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).
case_images: 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).
case_images: crn-0008-0010-g03.jpg
case_images: PMC4748806_01_crn-0008-0010-g03.jpg
case_images: F3
case_images: Increased blood-brain barrier (BBB) permeability was repeatedly demonstrated as illustrated in the Reibergram (fig. 3).