Fig. 4

Axial MRI scans from Case 3. T2WI (a, b), FLAIR (c), and diffusion-weighted imaging (DWI) (d) performed at 3 days after disease onset at age 16 months showing high signal in the bilateral globus pallidus and substantia nigra (arrows). e-h, Follow-up images 20 days after clinical onset revealed more conspicuous lesions than the original scan, with a necrotic lesion on the left globus pallidus on T2-weighted (e, f) and diffusion-weighted imaging (g, h)(arrows). i-l, Follow-up images at 2.5 years after onset revealed that lesions on the substantia nigra disappeared (j) and lesions on the globus pallidus were smaller, with well-delineated cysts (i, k) (arrows) and without new lesions and brain atrophy