case_images: PMC10914381_01
case_images: Cardinal eye position. a Initial presentation. b Five weeks after treatment. The improvement of RE adduction and LE abduction.
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case_images: F1
case_images: There was an RE adduction deficit and LE abduction deficit on attempted left gaze (shown in Fig. 1a), and no nystagmus during saccadic eye movements. On follow-up visit 5 weeks later, there was no complaint about diplopia with complete resolution of ocular motility (shown in Fig. 1b).
case_images: Left facial nerve palsy. a Initial presentation. b Twelve weeks after treatment.
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case_images: F2
case_images: Neurological examination showed left facial nerve palsy (shown in Fig. 2a). Ipsilateral facial nerve palsy was fully resolved at the follow-up visit in week twelve after starting the treatment. (shown in Fig. 2b).
case_images: Brain MRI findings support diagnostic criteria for MS. Note the arrow. a Sagittal T2W FLAIR MRI showing hyperintense lesions in periventricular white matter perpendicular to the ventricles (Dawson's fingers) (arrow). b Sagittal T2W FLAIR MRI showing multiple small, round, hyperintense lesions in the left and right cortex and juxtacortical cerebellar hemisphere. The enhancement in post-contrast images. c-f Axial T2W and T2W FLAIR MRI showing small hyperintense lesion in the left paramedian pontine reticular formation (PPRF) area in the dorsal of pons (arrow). The enhancement in post-contrast and diffusion-weighted imaging.
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case_images: F3
case_images: Brain MRI on T2-weighted (T2W) fluid attenuated inversion recovery (FLAIR) demonstrated hyperintense lesions in periventricular white matter perpendicular to the ventricles (Dawson's fingers) (shown in Fig. 3a), multiple small, round, hyperintense lesions the left and right cortex and juxtacortical cerebellar hemisphere with post-contrast enhancement of lesions (shown in Fig. 3b); also small hyperintense lesion in the left paramedian pontine reticular formation (PPRF) in dorsal of pons with post-contrast enhancement of lesion (shown in Fig. 3c-f), that met 2017 revised McDonald's criteria of dissemination in time and space, suggesting the diagnosis of MS.
case_images: Brain MRI findings rule out acute ischemia. Hyperintensity on diffusion-weighted imaging caused by T2 shine through supported by normal ADC and ADC exponential not hyperintense.
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case_images: F4
case_images: Hyperintensity on diffusion-weighted imaging was not caused by restricted diffusion but rather T2 shine through, supported by normal apparent diffusion coefficient (ADC) and ADC exponential not hyperintense (shown in Fig. 4), rule out the common cerebrovascular etiology in this age group.