case_images: PMC4808664_01
case_images: (a) Coronal postcontrast T1 weighted magnetic resonance (MR) image shows areas of old (chronic) infarction in the equators of both cerebellar hemispheres (short white arrows) and small, enhancing subacute infarcts in right cerebellum (long white arrows). (b) Axial postcontrast T1 weighted MR image shows areas of old (chronic) infarction in both cerebellar hemispheres (single white arrows) and an enhancing subacute infarct in the right cerebellum (double white arrow). (c) Axial diffusion weighted MR image (DWI) through the posterior fossa shows a small, old right cerebellar infarct (short white arrow) and areas of subacute infarction with diffusion restriction (long white arrows).
case_images: CRINM2016-7024120.001.jpg
case_images: PMC4808664_01_CRINM2016-7024120.001.jpg
case_images: fig1
case_images: Magnetic resonance imaging (MRI) of the brain obtained at the time of initial presentation demonstrated areas of old, chronic infarction at the equators of both cerebellar hemispheres (short white arrows in Figures 1(a) and 1(b)), in the watershed regions between the superior cerebellar and posterior inferior cerebellar artery vascular territories. There were also enhancing areas of subacute infarction in the right cerebellum (long white arrows in Figures 1(a), 1(b), and 1(c)).
case_images: (a) Sagittal T2 weighted Fast Spin echo (FSE) MR image shows spinal cord expansion (swelling) with abnormal increased T2 signal extending from the C4 level to the T2 level (between the white arrows). (b) Sagittal DWI trace image shows abnormal increased signal intensity between C4 and T2, corresponding to the abnormal T2 signal noted on Sagittal T2 FSE imaging. (c) Sagittal apparent diffusion coefficient (ADC) map shows abnormal restriction of diffusion (dark signal in spinal cord indicated by arrows and asterisks) indicating that the increased signal on the DWI trace image represents diffusion restriction (not T2 shine through). (d) Axial T2 weighted FSE image at the C4 level shows cord expansion (swelling) and abnormal increased T2 signal within the swollen, edematous central gray matter (single asterisks indicate anterior horns and double asterisks indicate posterior horns of central gray matter). White arrows indicate uninvolved dorsal columns of the spinal cord.
case_images: CRINM2016-7024120.002.jpg
case_images: PMC4808664_01_CRINM2016-7024120.002.jpg
case_images: fig2
case_images: T2 level. The cord signal abnormality was primarily confined to the central gray matter (asterisks in Figure 2(d)). The clinical presentation and imaging findings were most compatible with anterior spinal artery distribution acute SCI; however, considering the possible patchy enhancement, transverse myelitis remained initially on the differential diagnosis.