Article Figures & Data
Figures
- Fig 1.
Patient 1. Images at presentation (A) and follow-up 5 (B–E) and 45 (F) days later.
A, Axial T2-weighted image shows abnormal hyperintensity in the mammillary bodies (arrow) and tectum.
B–D, Axial T2-weighted images show abnormal hyperintensity in the periaqueductal region, thalami, basal ganglia, and frontal area. Lesions are bilateral and symmetric.
E, DWI (ADC) shows restricted diffusion in the basal ganglia. Thalami have hypointensity and hyperintensity, which are presumed to represent cytotoxic and vasogenic edema, respectively.
F, Axial T2-weighted image shows diffuse parenchymal loss, severe atrophy of the caudate nuclei, and necrosis of the putamina.
- Fig 2.
Patient 2. Axial T2-weighted images.
A, At presentation, large area of hyperintensity is present in the pons.
B, Involvement of the frontal region, up to the motor cortex, is extensive.
- Fig 3.
Patient 4. Axial images at presentation.
A, T2-weighted image.
B, T1-weighted contrast-enhanced image shows extensive frontal injury. Note enhancement of both cortex and white matter.
- Fig 4.
Patient 5.
A, T2-weighted image shows subtle abnormal findings, slight hyperintensity of the anterior frontal region, and localized areas of blurring of the cortical stripe.
B, DWI (ADC) indicates restricted diffusion compatible with cytotoxic edema.
- Fig 5.
Patient 6. Proton MRS image from the periaqueductal region (TR/TE = 1500/144).
A, At presentation. Note the negative doublet of lactate. NAA/Cr ratio is reduced 1.11.
B, Five weeks later, the lactate doublet is no longer seen. NAA peak is higher than before.
Tables
Pt.No. Age(months) Gender Lactate Levels Outcome Length of Follow-up (months) Blood CSF 1 8.5 F ↑ ↑ Dysphagia; severe DD 4 2 4.5 F ↑ ↑ Dysphagia; mild DD 5 3 10 M ↑ ↑ Dysphagia; moderate DD 4 4 4.5 F N ↑ Mild DD 5 5 2 F ↑ ↑ Complete recovery 2 6 5 F ↑ ↑ Mild DD; ataxia 4 Note.—↑ indicates elevated; N, normal; DD, developmental delay.
PatientNo. Date ofMR Periaqueductal DW Brain stem DW Tectum MammillaryBodies Thalami DW Caudate DW Putamen DW Frontal Cortexand WM DW VolumeLoss 1 25.9.03 − N − N + + − N − N − N − N − 1.10.03 + C,V + N + + + C,V + C + C + C − 7.11.03 +Imp N − N Necrosis Atrophy +Necrosis N Hem Atrophy Necrosis N Hem Atrophy Necrosis N Laminar necrosis Leukomalacia N + 2 5.11.03 + N + C − + + C − C − N + C − B1→ 10.11.03 − NA − NA − + +Imp NA − NA − NA Imp cortex NA − 26.11.03 − N + N − Atrophy − N − N − N Laminar necrosis Leukomalacia N + 3 3.11.03 + NA − NA − − + NA − NA + NA + NA + B1→ 17.11.03 +Imp N − N − Atrophy +Imp N +Worse C + C +Imp N Worse 4 25.9.03 + V + N − + + V − N + N + V + 8.11.03 − N − N − − Imp N + N + N +Imp N Worse 5 6.11.03 − N − N − NA − N − N − N − C − 6 13.10.03 + N − N − + + N − N + N + N − B1→ 17.11.03 − N − N − − − N − N Necrosis N + N − 9.2.04 − N − N − − − N − N Atrophy N + N + Note.—+ indicates high signals on T2, FLAIR, or PD; −, normal signals; DW, diffusion-weighted images; C, cytotoxic edema; V, vasogenic edema; WM, white matter; NA, not available. N, normal or no signs of acute edema; Imp, improvement; Hem, hemorrhage; B1, start of treatment with B1.
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