case_images: PMC4295524_01
case_images: Pretreatment MRI.. Notes: (A-D, Top) Findings in brain images (images A, B FLAIR axial sequences and images C, D FLAIR sagittal sequences) are typical for primary demyelinating disease with several callosal plaques. (A-B, Bottom) Thoracic images (image A, T2 sagittal and image B, T2 axial), suggest possible demyelinating plaque at T3-4.. Abbreviations: MRI, magnetic resonance imaging; FLAIR, fluid-attenuated inversion recovery.
case_images: imcrj-8-023Fig1.jpg
case_images: PMC4295524_01_imcrj-8-023Fig1.jpg
case_images: f1-imcrj-8-023
case_images: MRI testing of the patient's brain without enhancement showed findings typical for primary demyelinating disease, with several callosal plaques, right greater than left (Figure 1).
case_images: MRI following treatment with IVMP for 5 days.. Notes: T2 sagittal (image A) and axial (images B, C) images and T1 with gadolinium (image D) show new dorsal pontine white matter lesion as depicted by the arrows in image A and image B, located slightly eccentric to the right. Images do not show abnormal enhancement. No other changes were seen compared with pretreatment.. Abbreviations: IVMP, intravenous methylprednisolone; MRI, magnetic resonance imaging.
case_images: imcrj-8-023Fig2.jpg
case_images: PMC4295524_01_imcrj-8-023Fig2.jpg
case_images: f2-imcrj-8-023
case_images: The MRI revealed a new dorsal pontine white matter lesion located slightly eccentric to the right that was consistent with the clinical hypothesis of a demyelinating lesion affecting cranial nerve VII (Figure 2).
case_images: MRI 5 months following treatment with ACTH gel for 5 days, followed by monthly IV natalizumab.. Notes: Images are compatible with the patient's known history of demyelinating disease. The lesion in the dorsal pons, shown by the arrows in image A (FLAIR sagittal) and image B (FLAIR axial), is less prominent than was seen prior to treatment with ACTH gel and IV natalizumab.. Abbreviations: ACTH, adrenocorticotropic hormone; IV, intravenous; MRI, magnetic resonance imaging; FLAIR, fluid-attenuated inversion recovery.
case_images: imcrj-8-023Fig3.jpg
case_images: PMC4295524_01_imcrj-8-023Fig3.jpg
case_images: f3-imcrj-8-023
case_images: MRI testing of the brain revealed findings compatible with the patient's known history of demyelinating disease; however, the previously described lesion in the dorsal pons was less prominent (Figure 3).