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Multiple right cerebral hemisphere heterogeneously enhancing and necrotic irregular mass lesions are seen as follows:
- A right anterior frontal para-falcine mass lesion is seen measuring 4.5 X 3.4 X 3.1 cm. The lesion is heterogeneously hypointense T1 and hyperintense T2 / FLAIR signal with heterogeneous predominantly marginal post-contrast enhancement. The lesion shows restricted diffusion with of its enhancing peripheral portion.
- Other similar lesions are seen at the right hypothalamus and the floor of the 3rd ventricle as well as the right thalamic regions, measuring about 2.5 X 2.5 X 1.5 and 1.5 X 1.5 X 1 cm, the lesions are seen surrounded by vasogenic brain oedema with compression of the 3rd ventricle and moderate supratentorial hydrocephalus as well as transpendymal periventricular CSF permeation . Mild contra-lateral left midline shift about 5 mm is noted.
- Other smaller subcentimetric enhancing lesions are seen at the right high frontal region.
- MR spectroscopy of the lesion shows significant depression or almost nullification of the neuronal markers; N-acetyl aspartate (NAA) and creatine (Cr) with slight elevation of the choline. Single voxel MR spectroscopy show significant elevation of the lipid / lactate.
- Bilateral cerebral demyelinating foci of high T2 / FLAIR signal are seen within the corona radiata and centrum semiovale.