case_images: PMC9755887_01
case_images: (A1-A4) Brain plain MRI before treatment. (B1-B4) Brain T1-enhanced MRI. (C1-C4) Brain plain MRI after treatment. (D1-D4) Brain plain MRI after 3 months of treatment. (A1/C1/D1) Transverse T1 weight imaging. (A2/C2/D2) Transverse T2 weight imaging. (A3/C3/D3) Fluid attenuated inversion recovery (FLAIR). (A4/C4/D4) Sagittal T2 weight imaging.
case_images: fneur-13-1013413-g0001.jpg
case_images: PMC9755887_01_fneur-13-1013413-g0001.jpg
case_images: F1
case_images: Cranial magnetic resonance imaging (MRI) plain scans revealed hypointensity on T1-weighted image, hyperintensity on T2-weighted image and fluid-attenuated inversion-recovery (FLAIR) signals in the bilateral semi-oval center, left frontotemporal parietal insula, right frontal lobe, left internal capsule hindlimb, left thalamus, left cerebral peduncle, and left pons (Figure 1). MRI showed linear and nodular enhancement within the lesions (Figure 1). Magnetic resonance spectroscopy (MRS) imaging showed that the N-acetyl aspartic acid (NAA) peak decreased significantly in the center and the edge of the lesions, and the choline peak was normal, suggesting demyelinating lesions (Figure 2). The positron emission tomography/computed tomography (PET/CT) scan of the whole body presented reduced glucose metabolism of cranial lesions (Supplementary Figure 1). Cognitive Assessment (MoCA). Compared to the previous scans, MRI plain scans of the head showed that lesions of the right frontal insula, the left hind limb of the internal capsule, and the left thalamus had been absorbed and lesions of the bilateral semioval center and the left temporal parietal insula, the left cerebral foot, and the left pontine were smaller than the front (Figure 1).
case_images: (A) Normal region. NAA/Cho = 1.74. (B) Edge of the lesion. NAA/Cho = 1.17. (C) Center of the lesion. NAA/Cho = 0.992. NAA, N-acetyl aspartic acid; Cho, Choline.
case_images: fneur-13-1013413-g0002.jpg
case_images: PMC9755887_01_fneur-13-1013413-g0002.jpg
case_images: F2
case_images: MRI showed linear and nodular enhancement within the lesions (Figure 1). Magnetic resonance spectroscopy (MRS) imaging showed that the N-acetyl aspartic acid (NAA) peak decreased significantly in the center and the edge of the lesions, and the choline peak was normal, suggesting demyelinating lesions (Figure 2).