Contrasting diagnostic challenges of headache before and after acute disseminated encephalomyelitis in children: Two case reports and review of literature

Figure 4 Case 2. A and B: Brain magnetic resonance imaging (MRI) of case 2 at initial acute presentation (day 0). Axial T2-weighted fluid-attenuated inversion recovery (FLAIR) sequence (A) and axial T2-weighted fast spin-echo sequence (B), both demonstrating large, confluent, poorly marginated bilateral cerebral white-matter hyperintensities consistent with acute disseminated encephalomyelitis, with no restricted diffusion or pathological contrast enhancement; C: Pre-retreatment follow-up brain MRI of case 2 obtained at 3-month readmission (day +90, before corticosteroid retreatment). Showing persistent white-matter hyperintensities without new demyelinating lesions; D: Final follow-up axial T2-weighted FLAIR brain MRI of case 2 obtained at month 4 (day +120, exactly 4 weeks following the completion of repeat corticosteroid therapy). Demonstrating near-complete resolution of the prior cerebral white-matter lesions and absence of new demyelinating activity.