Figure 1.

Progression of MRI Findings (A) MRI brain with and without intravenous contrast; Axial diffusion-weighted imaging (DWI) (left), FLAIR (middle) and T1 post-contrast (right) images obtained at the time of initial presentation to our institution demonstrated cortically-based increased signal within the paramedical frontal lobes and insular cortices bilaterally. Additional diffusion restriction is present within bilateral caudate heads and the left putamen. (B) Follow up MRI brain without contrast; axial DWI) (left), FLAIR (middle) and T1 post-contrast (right) images obtained 4 days later demonstrate unchanged cortically-based and basal ganglia diffusion restriction. FLAIR images also reveal new patchy subcortical white matter hyperintensity with involvement of the subcortical U-fibers. Contrast enhancement of pachymeninges seen diffusely.