case_images: PMC11732268_01
case_images: Head computed tomography imaging. The sagittal (A), axial (B), and coronal plane (C) images showed a subcortical focal area of low attenuation (red arrows) in the right precentral gyrus compatible with ischemic stroke.
case_images: encephalitis-2024-00094f1.jpg
case_images: PMC11732268_01_encephalitis-2024-00094f1.jpg
case_images: f1-encephalitis-2024-00094
case_images: CT demonstrated a subcortical focal area of low attenuation in the precentral gyrus (Figure 1).
case_images: 3-T magnetic resonance imaging sequences. The axial three-dimensional fluid-attenuated inversion recovery (A) showed an area of hyperintensity and axial diffusion-weighted imaging (DWI) with 1,000 b-value (B), and the relative apparent diffusion coefficient map (C) showed no significant restriction of diffusion. There is a T2 shine-through effect, but DWI showed a rim of hypointensity at the cortical side of lesions (red arrow) involving the subcortical U-fibers. Pre- (D) and post-gadolinium sequences (E, F) on sagittal and axial planes showed an area of hypointensity in the precentral gyrus on the T1-weighted sequence without significant enhancement after administration of contrast agent.
case_images: encephalitis-2024-00094f2.jpg
case_images: PMC11732268_01_encephalitis-2024-00094f2.jpg
case_images: f2-encephalitis-2024-00094
case_images: The DWI sequence demonstrated no significant restriction of diffusion but a rim of hypointensity on the cortical side of lesions (Figure 2).
case_images: 3-T magnetic resonance imaging. (A) The axial susceptibility-weighted imaging (SWI) sequence showed a hypointense subcortical linear alteration barely visible on the diffusion-weighted imaging sequence, involving the subcortical U-fibers. (B) The SWI phase image showed a hyperintense linear alteration in the same area. This indicated the presence of magnetic micro-susceptibility phenomena from deposits of material with paramagnetic properties.
case_images: encephalitis-2024-00094f3.jpg
case_images: PMC11732268_01_encephalitis-2024-00094f3.jpg
case_images: f3-encephalitis-2024-00094
case_images: This was confirmed to involve the subcortical U-fibers and is better appreciated in the SWI sequence (Figure 3).
case_images: 3-T magnetic resonance imaging. (A) The axial 3D-FLAIR sequence showed multiple hyperintense areas extending on the precentral gyrus, semioval center, right and left corona radiata, and right and left parietal lobes. (B) The axial SWI sequence showed a hypointense subcortical linear alteration involving the subcortical U-fibers. (C) Axial DWI (b-value, 1,000) and the relative ADC map showed faint restriction in the right precentral gyrus. The axial pre- (D) and post-gadolinium T1-weighted sequences (E) showed multiple confluent areas of hypointensity without significant enhancement after administration of the contrast agent.. 3D FLAIR, three-dimensional fluid-attenuated inversion recovery; SWI, susceptibility-weighted imaging DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient.
case_images: encephalitis-2024-00094f4.jpg
case_images: PMC11732268_01_encephalitis-2024-00094f4.jpg
case_images: f4-encephalitis-2024-00094
case_images: On MRI, we observed massive progression of T2-weighted FLAIR areas of hyperintensity extending to the precentral gyrus, semioval center, and corona radiata and partially to the parietal lobes (Figure 4).