Fig. 2

Serial MRI examination of patient 1. a Sagittal T2 weighted baseline MRI showing no involvement of the brainstem or of the spinal cord. b-e Follow-up MRI 5 month later revealed a new spinal cord lesion extending over 4 vertebral segments with cord swelling on T2-weighted imaging as well as new lesion formation in the pons and medulla oblongata with gadolinium enhancement on T1-weighted imaging. Within the following 5 months clinical symptoms deteriorated further with infratentorial T2 lesion enlargement and new lesion formation in the pons, e.g. adjacent to the middle cerebellar peduncle, accompanied by gadolinium enhancement (f)