case_images: PMC10566268_01
case_images: A: Axial T2 FLAIR from HD2. Increased FLAIR signal abnormality within the left greater than right temporal lobe. In the left temporal region abnormal signal extends into the left parahippocampal gyrus and medial aspect of the left thymus. Areas of abnormal signal indicated with arrows. B (Right): Axial T2 FLAIR from HD5. Mildly increased (compared to HD2) signal involving left greater than right medial temporal lobes and hippocampus bilaterally with areas of cytotoxic edema in the hippocampi. Areas of abnormal signal indicated with arrows.
case_images: 10.1177_2329048X231206935-fig1.jpg
case_images: PMC10566268_01_10.1177_2329048X231206935-fig1.jpg
case_images: fig1-2329048X231206935
case_images: Non-contrast brain MRI on HD2 (within 6 h of admission to our hospital) demonstrated minimally increased fluid-attenuated inversion recovery (FLAIR) signal abnormality within bilateral mesial temporal lobes, left greater than right (Figure 1A). Abnormal signal extended into the left parahippocampal gyrus and medial aspect of the left thalamus (Figures 1A and 2A). Imaging again demonstrated mildly increased abnormal T2 FLAIR signal involving bilateral medial temporal lobes and bilateral hippocampi (Figure 1B). Areas of cytotoxic edema in the hippocampi were again noted (Figures 1B and 2B).
case_images: A (Left): Axial T2 propeller from HD2. Axial T2 imaging from HD2 demonstrating signal abnormalities with more extensive signal changes on the left versus right, demonstrated by white arrows. B (Right): Axial T2-weighted image from HD5. Axial T2 imaging from HD5 demonstrated enhanced signal bilaterally, worse on right side versus left, demonstrated by white arrows.
case_images: 10.1177_2329048X231206935-fig2.jpg
case_images: PMC10566268_01_10.1177_2329048X231206935-fig2.jpg
case_images: fig2-2329048X231206935
case_images: Abnormal signal extended into the left parahippocampal gyrus and medial aspect of the left thalamus (Figures 1A and 2A). Areas of cytotoxic edema in the hippocampi were again noted (Figures 1B and 2B).
case_images: SWI from HD5. SWI from HD5 demonstrating microhemorrhages with more extensive hemorrhaging on the right versus left, demonstrated by white arrows. Comparatively, no microhemorrhages were appreciated on HD2 MRI SWAN (not shown).
case_images: 10.1177_2329048X231206935-fig3.jpg
case_images: PMC10566268_01_10.1177_2329048X231206935-fig3.jpg
case_images: fig3-2329048X231206935
case_images: Suspected microhemorrhages (more extensive on right vs left) were appreciated on susceptibility weighted imaging (SWI) (Figure 3).