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. 2021 Jan 26;96(4):e538–e552. doi: 10.1212/WNL.0000000000011210

Figure 4. Cyst-Like White Matter Lesions in Patients With ACTA2 Arg179.

Figure 4

Upper row shows fluid-attenuated inversion recovery (FLAIR)-weighted, lower row shows T2-weighted images to illustrate CSF-like signal intensity of cyst-like white matter lesions (CL). (A) Magnification of multiple CLs (black arrows). (B) Baseline (left) and 3-year follow-up (right) of the same ACTA2 Arg179 patient to illustrate emergence of an additional CL in the left frontal white matter (white arrow). (C) Same patient as in A. Coronal imaging illustrates round to ovoid shape of CL (black arrows) in a different plane. (D) Magnifications to illustrate differences of CL and lacunes. The lesion in the right peritrigonal white matter was classified as a CL based on a smooth edge and round shape. In contrast, the star-shaped, irregularly edged lesion in the left caudate head was considered a lacune of presumed vascular origin. (E) Individual longitudinal data on numbers of CL.