case_images: PMC7461882_01
case_images: (A-C) Initial cerebral MRI (axial T2 FLAIR) and corresponding T1 post-gadolinium image showing disseminated symmetrical contrast-enhanced lesions in bilateral pons, cerebellum, and area postrema (arrows). (D) Three months after the initial steroid therapy, axial T1 post-gadolinium enhanced brain MRI shows a decrease in the extent of abnormal gadolinium enhancement. (E,F,I) At relapse, axial T1 post-gadolinium brain MRI and coronal spinal MRI shows symmetrical punctate and curvilinear enhancing lesions in bilateral brainstem, cerebellum, periventricular and subcortical white matter, and spinal cord. (G,H) Sagittal and axial spine MRI shows multiple small lesions in cervical and thoracic spinal segments.
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case_images: PMC7461882_01_fneur-11-00730-g0001.jpg
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case_images: Magnetic resonance imaging (MRI) of the brain (Dec. 2018) exhibited disseminated symmetrical lesions distributed in the bilateral pons, cerebellum, AP, and periventricular and subcortical white matter; the lesions showed gadolinium enhancement (Figures 1A-C). Spine MRI exhibited multiple lesions in cervical and thoracic spinal segments (Figures 1G,H). At the 3-month follow-up (April 2019), she had fully recovered with distinctly reduced abnormal gadolinium enhancement on cranial contrast MRI (Figure 1D). Repeat contrast MRI showed recurrence of diffuse, symmetrical small punctate gadolinium enhancing lesions (pepper-like) in the brain (especially pons) and spinal cord (Figures 1E,F,I).