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Fig. 1 | BMC Neurology

Fig. 1

From: Possible progressive multifocal leukoencephalopathy and active multiple sclerosis under dimethyl fumarate: the central role of MRI in informing therapeutic decisions

Fig. 1

Selected MRI findings in our Multiple Sclerosis (MS) case. At the baseline exam (September 2016, upper row) a typical radiological MS pattern was present. When the patient presented a subacute clinical worsening (July 2019, middle row), brain MRI scan showed the presence of four new confluent Fluid Attenuated Inversion Recovery (FLAIR) hyperintense lesions (red arrows), with involvement of the U-fibers, a sharp border between the superficial aspect of the lesion and the overlying cortex and an ill-defined deeper border. Three of these lesions showed a punctate peripheral contrast-enhancement (green arrows) and a mild, but consistent, hypointense subcortical rim in Spoiled Gradient Recalled (SPGR) images (blue arrows), suggestive of PML lesions. Along with these lesions, a left frontal oval-shaped lesion showed a different pattern of contrast enhancement compared to the other lesions (orange arrow), in absence of hypointense signal in SPGR images (yellow arrow), more suggestive of active MS rather than a PML lesion. At a follow-up examination (January 2020, lower row), the PML lesions showed an almost complete resolution, in absence of significant sequelae, while the oval-shaped FLAIR hyperintense lesion was still present, although reduced in volume

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