case_images: PMC10898214_01
case_images: (a) Disease course illustration: a visual representation outlining the progression of our patient's medical journey. (b) Indirect immunofluorescence staining: a representative image showcasing the immunofluorescence staining of our patient's CSF on rat cerebellar sections. The white box designates the region of focus magnified in (c). (d) MRI image - rhombencephalitis and mesiotemporal hyperintensities: axial FLAIR image exhibiting the presence of rhombencephalitis and mesiotemporal hyperintensities, indicated with arrows. (e) MRI image - basal meningeal enhancement: coronal FLAIR post gadolinium contrast enhancement image illustrating basal meningeal enhancement, depicted by the white arrow. (f) Doppler-duplex sonography: an image derived from Doppler-duplex sonography conducted on the basal brain arteries, demonstrating accelerated blood flow (300 cm/s). (g) Pelvic CT scan - ovarian mass lesion: pelvic CT scan revealing a partially calcified mass lesion within the right ovary, highlighted by the white arrow.. Image created with Biorender.. CSF, cerebrospinal fluid; FLAIR, Fluid Attenuated Inversion Recovery.
case_images: 10.1177_17562864231224108-fig1.jpg
case_images: PMC10898214_01_10.1177_17562864231224108-fig1.jpg
case_images: fig1-17562864231224108
case_images: Thereafter, she had struggled to resume work and had undergone a temporary hospitalization for depression and anxiety [Figure 1(a)]. Approximately 3 weeks before her presentation, she recalled experiencing a tick bite, but was unaware of any subsequent rash or exanthema [Figure 1(a)]. Furthermore, immunohistochemistry studies demonstrated a distinct fluorescence pattern on rat cerebellar sections, specifically highlighting staining within the granular and molecular cell layers [Figure 1(b) and (c)]. Cranial MRI results revealed signs of basal meningitis and rhombencephalitis, accompanied by mesio-temporal hyperintensities [Figure 1(d) and (e)]. Duplex sonography performed on the brain arteries displayed evidence of blood flow acceleration within the vertebral and medial cerebral arteries, consistent with intracranial vasospasms [Figure 1(f)]. Subsequent pelvic CT-scan investigations unveiled the presence of a partially calcified mass lesion located within the right ovary [Figure 1(g)].