case_images: PMC10602719_01
case_images: T2-FLAIR MRI revealed hyperintensities in the temporal, parietal, occipital lobes, left caudate nucleus, and right cerebellum (A). An MRA indicated multifocal, segmental, and diffuse narrowing of cerebral arteries (large and medium) [(B), red arrows]. After 10 days, complete remission of abnormalities was observed in a follow-up MRI compared to the previous signals (C). An MRA demonstrated significant cerebral artery recovery from diffuse segmental constriction (D).
case_images: fneur-14-1281074-g001.jpg
case_images: PMC10602719_01_fneur-14-1281074-g001.jpg
case_images: fig1
case_images: An MRI scan revealed hyperintensities inside the temporal, parietal, and occipital lobes, left caudate nucleus, and right cerebellum on T2-FLAIR imaging (Figure 1A) without the restriction of diffusion displayed on diffusion-weighted imaging. MR venography gave a normal result, leading to the exclusion of cerebral venous infarction. MR angiography indicated multifocal, diffuse, and segmental narrowing of arteries (both large and medium) within the anterior and posterior circulations, with occasional dilation of the segments (Figure 1B). MRI was performed, which indicated markedly attenuated abnormal signals (Figure 1C). MRA showed that the cerebral arteries, which were diffuse and segmentally constricted, were improved significantly (Figure 1D).
case_images: Axial and coronal gadolinium-enhanced T1-weighted MR images showed diffuse pachymeningeal enhancement [(A,B), red arrows].
case_images: fneur-14-1281074-g002.jpg
case_images: PMC10602719_01_fneur-14-1281074-g002.jpg
case_images: fig2
case_images: Additionally, the widespread enhancement of the dura mater indicated by the enhanced MRI could have been caused by low intracranial pressure syndrome (Figure 2), further decreasing the intracranial infection possibility.
case_images: RCVS2 score for reversible cerebral vasoconstriction syndrome.
case_images: fneur-14-1281074-g003.jpg
case_images: PMC10602719_01_fneur-14-1281074-g003.jpg
case_images: fig3
case_images: The patient had an RCVS2 score of six (Figure 3).