case_images: PMC4967458_01
case_images: (a) Axial brain MRI showed symmetric hypointensity in the bilateral basal ganglia on T1-weighted images. (b, c) Axial brain MRI showed symmetric hyperintensity in the focal region on T2-weighted images and FLAIR images. (d) Diffusion-weighted imaging revealed slightly higher inhomogeneous signals in the involved regions. (e) ADC map revealed that the ADC value of the involved regions is not low.
case_images: CRIRA2016-2407219.001.jpg
case_images: PMC4967458_01_CRIRA2016-2407219.001.jpg
case_images: fig1
case_images: Axial brain MRI revealed symmetric edema in the bilateral basal ganglia, which exhibited hypointensity on T1-weighted images (Figure 1(a)) and hyperintensity on both T2-weighted images (Figure 1(b)) and fluid-attenuated inversion recovery (FLAIR) images (Figure 1(c)). Diffusion-weighted imaging (DWI) demonstrated slightly higher inhomogeneous signals in the involved regions (Figure 1(d)). Concurrently, increased apparent diffusion coefficient (ADC) values were demonstrated in the periphery compared with normal brain tissue (Figure 1(e)), indicating vasogenic edema rather than cytotoxic edema.
case_images: (a, b) The lesions extended in both T1WI and T2WI after 3 weeks. (c) FLAIR images showed demyelination around bilateral ventricles and lacunar infarctions.
case_images: CRIRA2016-2407219.002.jpg
case_images: PMC4967458_01_CRIRA2016-2407219.002.jpg
case_images: fig2
case_images: Follow-up MRI of brain was performed 3 weeks later, which showed lesions worsened and extended in both T1WI (Figure 2(a)) and T2WI (Figure 2(b)). MR imaging revealed demyelination around bilateral ventricles and lacunar infarctions in FLAIR (Figure 2(c)). MR angiography showed atherosclerotic alterations of small brain vessels.
case_images: (a, b) MRS with region of interest pinpointed on the left basal ganglia lesion displayed a decrease of NAA/Cr value (2.04) and lactate doublet was detected. (c, d) 3D-ASL showed hyperperfusion in the lesion area and the rCBF was more than 160 mL/(100 g*min). (e) SWI findings indicated old microbleeds and hemosiderin deposition.
case_images: CRIRA2016-2407219.003.jpg
case_images: PMC4967458_01_CRIRA2016-2407219.003.jpg
case_images: fig3
case_images: Proton (1H) MR spectroscopy (MRS) (Figures 3(a) and 3(b)) with region of interest pinpointed on the left basal ganglia lesion displayed a decrease of N-acetylaspartate (NAA) peak and lactate (Lac) doublet. 3D-ASL results (Figure 3(c)) reflected the local perfusion condition, and the increased regional cerebral blood flow (rCBF) suggested hyperperfusion in the corresponding lesion area. Some dotted low signals were noted in the susceptibility weighted imaging (SWI) findings (Figure 3(e)).