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Fig 2. Patient 163. Increasing abnormality from day 1 to day 3.
A and B, Axial Dav maps at age 22 hours (day 1) show reduced diffusion in the ventrolateral thalami (arrows) and normal-appearing mesial temporal lobes in the region of the uncus.
C, Proton MR spectroscopy from left thalamus at 22 hours shows elevated lactate peak (Lac) and normal appearing NAA peak. The peak upfield from lactate is propane diol (ethylene glycol), which is administered as the base for antiseizure medications.
D and E, Axial Dav maps at age 64 hours (day 3) show more extensive reduced diffusivity. The mesial temporal lobes (D, white arrows) show reduced Dav, as do the cingula (E, black arrows) and the entire basal ganglia-thalami-insular region (E, white arrows).
F, Proton MR spectroscopy from left thalamus at 64 hours shows interval increase in lactate and decrease in NAA and choline (Ch) compared with creatine (Cr).
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