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. 2021 Feb 25;40:102000. doi: 10.1016/j.tmaid.2021.102000

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Fig. 1 — I.Case 1: Neuroimaging. Spine MRI performed in the acute phase (a–d) from C1 to D5 with sagittal (a), parasagittal (b) and axial (d) T2 Turbo Spin Echo (TSE) weighted images and post gadolinium sagittal T1-Spin Echo (SE) weighted images (c). Follow-up MRI performed 1-month later (e–g), with sagittal T2-SE (e) and axial T2-Fast Field Echo (FFE) sequences (f, g).

In the acute phase, a slight diffuse multifocal hyperintensity at the cervical level (a, b) and a blurred hyperintensity at D3 level (b, white arrow, and d) were detectable. No enhancement was evident after gadolinium injection (c). Follow-up MRI better showed multifocal cervical lesions at C3-C5 and C6-C7 (e), mainly involving the cervical lateral (f) and dorsal centro-medullary region (g).

II. Case 2: Neuroimaging. Spine MRI with sagittal T2 (a, b, f), sagittal T2-STIR sequences (c), post-contrast sagittal (d) and axial (g) T1 sequences of the cervical tract and post-contrast T1 sequence (e) of the lumbosacral tract. Cervical sequences detected a diffuse T2-and STIR-hyperintensity extending from the bulbo-medullary junction down to C6 (a–c, f), with peripheral enhancement and a relative sparing of the centro-medullary area (d, g). A marked post-contrast enhancement was noted in the conus, preeminently involving the anterior and posterior columns with a relative central sparing (e). Brain MRI with FLAIR (h) and T2 (i) sequences, showing a single right posterior periventricular lesion.

III. Case 3: Neuroimaging. Spine MRI with sagittal T2-Spin Echo (SE, a–c) and T2-STIR sequences (d, e) and axial T2-Fast Field Echo (FFE) sequences (f, g). Brain MRI (h, i) with axial FLAIR (h) and post–contrast T1-SE (i).

Spine MRI (a) shows multiple, predominantly posterior hyperintense cervical lesions at C3, C4-C5 level (arrows) and in the upper dorsal region (T1-T2, arrows), while a more extensive alteration is evident from T5 down to the epiconus (b–e). Axial slices (f, g) detect an “H-shaped” grey matter involvement (f), predominantly affecting the anterior horns (g). Brain MRI shows one single hyperintense lesion in the left superior cerebellar peduncle (h), without contrast enhancement (i).