Fig. 2.

Magnetic resonance imaging was done at the time of patient transfer a, c to the neuro-intensive care center and at 1 month of treatment b, d with influenza-specific antiviral therapy, corticosteroids, and intravenous gamma globulin therapy. a Coronal FLAIR image shows diffuse brain edema with sulcal effacement and symmetric hyperintensities selectively affecting the white matter and sparing cortex and subcortical nuclei such as basal ganglia and thalami. b Coronal FLAIR image at 1 month shows resolution of sulcal effacement, marked reduction in white matter hyperintensity, and relative brain atrophy (20 year old patient). c Diffusion-weighted imaging on admission showed some increased signal in the periventricular zones that were also bright on T2 and FLAIR sequences consistent with T2 shine-through. d Diffusion-weighted imaging at 1 month revealed hyperintensity in the caudate and putamen with corresponding decreased signal in ADC map and lack of hyperintensities on T2 and FLAIR sequences (see Fig 1b)