JMA Journal

Figure 1. MRI on admission revealed a hyperintense intramedullary lesion (red arrow) on the right side at the C4-C5 spinal level with extensive perilesional edema extending to the brainstem. Brain MRI showed no obvious abnormalities. (A: T2WI Sagittal; B, C: T2WI Axial).
MRI: magnetic resonance imaging; T2WI: T2 weighted image.

Figure 2. On the second day of hospitalization, a follow-up MRI showed progressive lesion expansion (red arrow) with worsening edema and ring-like enhancement on contrast-enhanced MRI, and high signal intensity on diffusion-weighted imaging in the same region. Brain MRI showed no changes compared to admission, with no hydrocephalus or findings suggestive of brain abscess or ventriculitis. (A: T2WI Sagittal; B1, 2: gadolinium-enhanced T1WI Sagittal, Axial; C: DWI Axial; D: T2WI Axial).
MRI: magnetic resonance imaging; T2WI: T2 weighted image.

Figure 3. Two months after surgery, the MRI revealed complete resolution of the abscess with resolution of surrounding edema. (T2WI Sagittal).
MRI: magnetic resonance imaging; T2WI: T2 weighted image.

Figure 4. Initial MRI showed edematous changes limited to the dorsal brainstem (A1, 2). When the patient developed impaired consciousness, the MRI revealed that the edema had spread to the central and ventral medulla (red arrows) (B1, 2). Postoperative imaging showed improvement in brainstem edema (C1, 2), which was accompanied by recovery of consciousness. (A1, B1, C1: T2WI Sagittal; A2, B2, C2: T2WI Axial). MRI: magnetic resonance imaging; T2WI: T2 weighted image.