Fig. 1

MRI of multifocal lesions on presentation. A Axial T2-FLAIR demonstrating a hyperintense round lesion, measuring 2.7 × 2.2 × 1.5 cm (CC × AP × transverse), in the precentral gyrus. Initial measurements prior to presentation at our institution: 2.2 × 1.7 × 1.5 cm. B Left greater than right hyperintensity in the cerebral peduncles on axial T2-FLAIR. C Axial T2-FLAIR demonstrates a heterogenous, hyperintense lesion in the pons, measuring 3.9 × 3.1 × 4.4 cm, with extension into bilateral cerebellopontine cisterns and middle cerebellar peduncles. Encasement of the basilar artery is also present with no obstruction of flow. Initial measurements prior to presentation at our institution: 3.5 × 3.1 × 4.3 cm. D Axial T1 post-contrast image of the pontine lesion demonstrating subtle patchy contrast enhancement. E Sagittal T2 image of the precentral lesion with compression of the central sulcus. F Large heterogenous, T1 hypointense pontine lesion extending from the floor the fourth ventricle to the prepontine cistern ventrally. G Pontine lesion as described with heterogenous hyperintensity on this sagittal T2 slice. H Subtle patchy enhancement is again appreciated within the pontine lesion on this T1 post-contrast sagittal slice