case_images: PMC10716429_01
case_images: Brain and spinal cord magnetic resonance imaging (MRI) scans of the 10-year-old patient. (A) Represents the first MRI taken of the patient after his initial presentation: unremarkable with no sign of acute or remote brain insult. (B-D) Represent the second set of MRIs taken approximately 5 weeks since the patient's initial visit: abnormal symmetrical T2 and FLAIR white matter high signal intensities are noted in the middle cerebellar peduncles, pons, and cortices with focal atrophic changes and compensatory ventricular enlargement. (E,F) Represent contrast-enhanced MRIs of brain and spinal cord: abnormal diffuse T2 signal intensities involving the central and anterior cord extending down to the conus medullaris.
case_images: fneur-14-1268035-g001.jpg
case_images: PMC10716429_01_fneur-14-1268035-g001.jpg
case_images: fig1
case_images: Family history revealed that the parents were first-degree cousins and had no history of similar problems of seizures or autoimmune diseases in the family (see Supplementary Figure S1 for pedigree). Brain computed tomography (CT) and magnetic Resonance Imaging (MRI) scans were performed, but the results were unremarkable (see Figure 1A). T2 and fluid-attenuated inversion recovery (FLAIR) white matter high signal intensity, focal atrophic changes and compensatory widening of the ventricular system (see Figures 1B-D). Brain MRI indicated further worsening of the diffuse brain parenchymal atrophy with resultant ventricular enlargement while spinal MRI revealed abnormal diffuse T2 signal intensities involving the central and anterior cord extending down to the conus medullaris (see Figures 1E,F).
case_images: Multi-voxel MR spectroscopy of the patient: short and long TE at the basal ganglia, peritrigonal white matter, and cerebellar peduncles with increased choline to creatinine ratio and a decreased N-acetylaspartate to creatine ratio suggest an underlying inflammatory or demyelinating process.
case_images: fneur-14-1268035-g002.jpg
case_images: PMC10716429_01_fneur-14-1268035-g002.jpg
case_images: fig2
case_images: Brain multi-voxel MR spectroscopy findings were further suggestive of an inflammatory or demyelinating process post-COVID-19 infection (see Figure 2). A concise but thorough timeline of all investigations and the clinical course of the patient is available in Supplementary Figure S2.