case_images: PMC10520721_01
case_images: Brain MR of the patient. T1-weighted imaging (A, B) and FLAIR (C, D) showed several lacunar foci in bilateral basal ganglia and thalamus, leukoencephalopathy, and atrophy. No hyperintense on DWI (E, F). MRI angiogram suggested stenosis of the left middle cerebral artery (red arrow) (G).
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case_images: PMC10520721_01_fneur-14-1241676-g0001.jpg
case_images: F1
case_images: The brain MR (Figures 1A-F) showed several lacunar foci in bilateral basal ganglia and thalamus (especially on the left), leukoencephalopathy, and atrophy. An MRI angiogram (Figure 1G) suggested intracranial arteriosclerosis and mild to moderate stenosis of the M1 segment of the left middle cerebral artery.
case_images: Ultrasound images of the temporal artery. Long-axis section of the temporal artery (A) exhibits irregular wall morphology characterized by thickening and the presence of a few punctate strong echo plaques. Short-axis section of the temporal artery (B) demonstrates non-uniform thickening with a non-smooth appearance.
case_images: fneur-14-1241676-g0002.jpg
case_images: PMC10520721_01_fneur-14-1241676-g0002.jpg
case_images: F2
case_images: Temporal artery ultrasound (TAU) showed hypoechogenic non-smooth thickening of the bilateral superficial temporal artery wall with the presence of a few punctate strong echo plaques (Figure 2), which could not tell vasculitis from atherosclerosis clearly.
case_images: Abnormal findings of arteries in PET-CT. The temporal arteries (A), subclavicular arteries, brachial trunk, axillary arteries, carotid arteries (B), aortic arch, descending aorta, abdominal aorta (C), and several other arteries showed an uneven increase in FDG uptake (red arrow, SUVmax distribution in 1.4-5.3), and corresponding CT showed slightly thicken vascular wall. Calcification can be seen in some artery walls.
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case_images: PMC10520721_01_fneur-14-1241676-g0003.jpg
case_images: F3
case_images: Vessel walls were slightly thickened, and strip calcification was seen in part of them (Figure 3).
case_images: Abnormal findings of joints in PET-CT. Atlantoaxial joint (red arrow) (A), lumbar spinous processes (B), sternoclavicular and shoulder joints (C), hip joints (D), knee joints (E), and several other regions showed an increase in FDG uptake (SUVmax: 4.2), and corresponding CT showed synovial thickening or bursae enlargement.
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case_images: PMC10520721_01_fneur-14-1241676-g0004.jpg
case_images: F4
case_images: In addition, increased FDG uptake (SUVmax: 4.2) could be seen in atlantoaxial, shoulder, wrist, hip, knee, sternoclavicular joints, and lumbar spinous processes, with synovium thickened or synovial capsule enlarged (Figure 4).