Fig. 1

MRI findings and treatment timeline of the patient. A–D On day 2 after admission, the T2-weighted image showed diffused subcortical white matter hyperintensities in both hemispheres, predominantly in the temporal and occipital lobes (A, B); the apparent diffusion coefficient map showed increased diffusivity of the lesion consistent with vasogenic edema (C); and SWI showed several cortical and subcortical CMBs in bilateral temporal lobes (D). Following initial MRI, high-dose methylprednisolone (1000 mg/day for 3 days and 500 mg/day for 3 days) and dehydration therapy were administered, with rapid improvement of neurologic symptoms observed within 1 week. Head CT on day 10 after withdrawal of methylprednisolone revealed significant aggravation of brain edema (see supplementary Fig. 1). E, F Ten days after high-dose methylprednisolone reinitiation, MRI showed that the edema had largely resolved, but innumerable cortical CMBs appeared on SWI. G, H MRI at the 3-month follow-up showed remarkable regression of white matter hyperintensities, with no change in CMBs. I Treatment timeline showing course of the disease with different treatments. GF, glycerol fructose; MP, methylprednisolone; MT, mannitol; PS, prednisone; TM, torasemide