Fig 5. Patient 193. New involvement of white matter pathways on second study. Studies performed at day 2 and day 7.
A–C, Axial Dav maps at 34 hours show reduced diffusivity (Dav reduced by about 50%, black arrows) in the ventrolateral thalami, posterior limbs of internal capsules, and corticospinal tracts in centrum semiovale. No other areas of reduced diffusivity are identified.
D, Proton MR spectroscopy from the left basal ganglia at 34 hours shows mild lactate (Lac) elevation.
E–H, Axial Dav maps at 148 hours show that diffusivity in the deep gray nuclei has normalized (values were within 5% of normal); however, new areas of reduced diffusivity are seen in what are believed to be the optic radiations (E, medium white arrows), corpus callosum (F, small white arrows; G, smaller white arrows), cingulum (H, medium white arrows), and superior longitudinal fasciculus (G, larger arrows).
I, Proton MR spectroscopy from left basal ganglia at 148 hours shows that lactate (Lac) has increased in comparison with NAA, choline, and creatine. NAA is the most reduced metabolite.