MRI
Axial T2
Axial FLAIR
Axial T1
Axial DWI
Axial ADC
Axial SWI
Axial T1 C+
Large, heterogeneous clustered cystic lesions in the left frontal white matter with significant peri-lesional oedema. The lesions are hyperintense on T2W images and hypointense on T1W images with no suppression on FLAIR. There are foci of small T2 hypointensities, few of them are eccentrically located within the cysts and few within the intervening region. Post contrast study shows heterogeneous peripheral rim enhancement. The perilesional oedema is seen to extend into the subcortical white matter and along the internal and external capsules. Mild mass effect is seen on the adjacent lateral ventricle and basal ganglia causing midline shift to the right side. Diffusion restriction is seen in the periphery of the cysts. SWI shows areas of blooming suggestive of calcifications.
Smaller, clustered cystic lesions with similar morphology and perilesional oedema are seen in the right frontal white matter. Post contrast study shows nodular enhancement along the postero-superior aspect.
Areas of T2 hypointensities with surrounding long TR hyperintensity in the right capsuloganglionic region, left thalamus and bilateral cerebellar hemispheres involving the dentate nuclei. These show intense blooming on SWI. Mild volume loss in the right capsuloganglionic region causing minimal exvacuo dilatation of the right lateral ventricle with resultant Wallerian degeneration along the right corticospinal tract.