case_images: PMC9062910_01
case_images: CT on admission shows no apparent abnormal lesions except for the left frontal cerebral lobe contusion (arrow) and shunt tube (arrowhead) that occurred in the SAH treatment. CT: Computed tomography, SAH: Subarachnoid hemorrhage.
case_images: SNI-13-129-g001.jpg
case_images: PMC9062910_01_SNI-13-129-g001.jpg
case_images: F1
case_images: On admission, computed tomography showed no apparent abnormal lesions, except for the left frontal cerebral lobe contusion that occurred in the SAH treatment [Figure 1].
case_images: Electroencephalography on admitting showed periodic lateralized epileptiform discharges in the left hemisphere (square).
case_images: SNI-13-129-g002.jpg
case_images: PMC9062910_01_SNI-13-129-g002.jpg
case_images: F2
case_images: However, on electroencephalography (EEG), periodic lateralized epileptiform discharges (PLEDs) were confirmed in the left hemisphere [Figure 2].
case_images: MRI findings 6 days after admission are shown as follows. (a) There are asymmetrical hyperintensity areas such as the left rectal gyrus, temporal lobe, parietal lobe, insular cortex (not shown), and thalamus (not shown) on FLAIR imaging (arrowhead). (b and c) DWI and ADC map show hyperintensity in the left cortical areas (arrow). (d) Increased signal intensity of the left MCA on MRA is revealed. DWI: Diffusion-weighted imaging, ADC: Apparent diffusion coefficient, FLAIR: Fluid-attenuated inversion recovery, MCA: Middle cerebral artery, MRA: Magnetic resonance angiography.
case_images: SNI-13-129-g003.jpg
case_images: PMC9062910_01_SNI-13-129-g003.jpg
case_images: F3
case_images: At that time, the most characteristic radiological findings for this patient, including asymmetrical hyperintensity on fluid-attenuated inversion recovery (FLAIR) imaging of magnetic resonance imaging in the left rectal gyrus, temporal lobe, parietal lobe, insular cortex, and thalamus, were revealed [Figure 3a]. Furthermore, lesions were described as mild high-intensity areas on diffusion-weighted imaging (DWI) [Figure 3b] and apparent diffusion coefficient (ADC) maps [Figure 3c]. Time-of-flight MR angiography showed increased visualization of the left middle cerebral artery [Figure 3d].
case_images: The following MRI shows that all radiological abnormal findings on admission had almost disappeared. (a) FLAIR and (b) MRA.
case_images: SNI-13-129-g004.jpg
case_images: PMC9062910_01_SNI-13-129-g004.jpg
case_images: F4
case_images: Abnormal radiological findings disappeared 132 days after admission [Figure 4a and b].