case_images: PMC10752983_01
case_images: Sequential Brain MRIs Following Symptom Onset. Brain images obtained at 1 year (A1-E1) and 3.5 years after the onset of symptoms (A2-E2) and (F-J). T1-weighted MRI revealed hypointense white matter lesions in the frontoparietal lobes (indicated by arrowheads) along with localized cerebral atrophy (A1). This lesion exhibited hyperintensity on T2 WI (B1), hypointensity on DWI (C1), and hyperintensity on the ADC (D1), along with enhancement on contrast-enhanced MRI (E1). At the 3.5-year mark from symptom onset, a solitary mass was identified in the right frontal lobe, exhibiting hyperintensity on T2 WI and contrast enhancement following gadolinium injection, accompanied by edema but without any mass effect. The corresponding images are shown in A2-E2. SWI showed microbleeds within the mass (F). MRS indicated an increased choline/creatinine ratio within the lesion (G). MRA did not reveal any vascular abnormalities (H). FDG-PET scans revealed atrophy in the right frontal lobe, right temporo-insula, right parietal, and right occipital cortex, along with multiple calcifications and reduced glucose metabolism, predominantly in the right frontal lobe and right temporo-insula (I,J). T1, T1-weighted imaging. T2, T2-weighted imaging. DWI, diffusion-weighted imaging. ADC, apparent diffusion coefficient. SWI, susceptibility weighted imaging. MRS, magnetic resonance spectroscopy. MRA, magnetic resonance angiography. FDG PET-CT, 18F-fluorodeoxyglucose PET-computed tomography.
case_images: fneur-14-1337410-g001.jpg
case_images: PMC10752983_01_fneur-14-1337410-g001.jpg
case_images: fig1
case_images: T2-weighted MRI obtained 1 year after the onset of symptoms displayed hyperintensity in the frontoparietal lobes, along with localized cerebral atrophy. This lesion exhibited hypointensity on diffusion-weighted imaging (DWI) and hyperintensity on the apparent diffusion coefficient (ADC) map (Figures 1A1-E1). MRI (Figures 1A2-E2). Magnetic resonance spectroscopy (MRS) indicated an increased choline/creatinine ratio within the lesion (Figure 1G). MR angiography (MRA) did not reveal any involvement of large-or medium-sized blood vessels (Figure 1H). FDG-PET scans revealed atrophy in the right frontal lobe, right temporo-insula, right parietal, and right occipital cortex, along with multiple calcifications and reduced glucose metabolism, predominantly in the right frontal lobe and right temporo-insula (Figures 1I,J).
case_images: Histological Examination of the Lesion. (A) Hematoxylin and eosin (HE) stain. (B) CD3 positive. The examination revealed dense perivascular chronic inflammation characterized by the presence of lymphocytes. Lymphocytes predominantly infiltrated and disrupted the walls of small blood vessels. Original magnificationx100.
case_images: fneur-14-1337410-g002.jpg
case_images: PMC10752983_01_fneur-14-1337410-g002.jpg
case_images: fig2
case_images: MRI (Figures 1A2-E2). Magnetic resonance spectroscopy (MRS) indicated an increased choline/creatinine ratio within the lesion (Figure 1G). MR angiography (MRA) did not reveal any involvement of large-or medium-sized blood vessels (Figure 1H). Histological analysis revealed lymphocytic vasculitis (Figure 2).
case_images: A time course of events.
case_images: fneur-14-1337410-g003.jpg
case_images: PMC10752983_01_fneur-14-1337410-g003.jpg
case_images: fig3
case_images: A time course of events can be found in Figure 3.