Fig. 1

Chronological order of MRI scans from May 4th 2007 until August 15th 2014. a Images show normal deep nuclei and some unspecific small T2-weighted (T2w) hyperintensities. b The cranial T2w sequence depicts the high lesion load accompanied by several black holes in T1-weighted (T1w) sequences. Left-outermost column a–b. The boxes indicate a small nodular enhancement in the right precentral gyrus underlining disease progression. c The 2nd exam on May 18th, 2007 reveals the onset of space occupying haemorrhagic changes in the deep nuclei as well as hemorrhagic subcortical foci; hemorrhages are indicated by unenhanced T1w-hyperintensities. d–e The examinations from May 23rd und June 8th show a slow regression of the oedema and the size of the hemorrhagic areas. At both time points and in addition to the T1w signal hyperintensities caused by hemorrhagic residua, contrast enhancements can be found at the outer rim of the lesions. f By August 15th, 2014, only parenchymal defects are remaining together with distinctive brain volume loss leading to enlargement of ventricles. g Axial fluid attenuated inversion recovery imaging (FLAIR) shows an increase in lesions load. Both in the FLAIR and T1w image, confluent and mainly periventricular located lesions are found. Left-outermost column f–g. Boxes indicate a small enhancing focus in the left frontal hemisphere evidencing disease activity in multiple sclerosis. Images from May 5th, 2007 are with courtesy of Röntgenpraxis Georgstrasse, Hannover; images from August 15th, 2014 are with courtesy of Röntgenpraxis Marstall, Hannover. N/A not available