FIG 1. Serial MR images in a patient receiving hydroxyurea. The first examination was performed at another institution.

A, Examination 1. T1-weighted image shows mild atrophy in the left medial frontal lobe.

B, Examination 1. Fluid-attenuated inversions recovery image demonstrates a recent infarction in the right middle cerebral artery territory, as well as a remote left anterior cerebral artery infarct, bilateral deep white matter leukoencephalopathy, and a few scattered deep white matter lacunae.

C, Examination 2. Image obtained at our institution almost 1 year after the beginning of therapy shows further progression of mild diffuse cerebral atrophy.

D, Examination 5. Approximately 4 years after the beginning of hydroxyurea therapy moderate diffuse cerebral atrophy is present, with prominent sulci and further ex vacuo dilatation of the ventricular system.