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FIG 1. Patient 1.
A, Symmetrical high signal intensity in the globi pallidi is demonstrated (*) on fast-FLAIR (8800/140/2200 [TR/TEeff/TI]) and T2-weighted FSE (5015/97 [TR/TEeff]) MR images. On the diffusion-weighted (10,000/100 [TR/TE]) (b = 1000 s/mm2) MR image, the lesions were mildly hyperintense anteromedially and markedly hyperintense posterolaterally (arrowheads). The ADCave map demonstrated symmetrical low signal intensity (restricted diffusion) in the posterolateral portions of the globi pallidi (arrowheads), consistent with acute infarctions. Metabolic images showed symmetrical bilateral decreases in NAA and increases in Lac in globi pallidi (*), also consistent with acute infarction. Other brain regions appeared normal, and no Lac was detected in CSF.
B, Single-voxel short-TE spectrum (2000/30 [TR/TE]) of the left globus pallidus shows decreased levels of NAA and increased levels of Lac compared with controls (not shown). Levels of other metabolites are within normal limits (Glu, glutamate and glutamine; mI, myo-inositol)
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