Fig. 1

The patient’s brain magnetic resonance imaging (MRI) findings. MRI data demonstrated bilateral lesions (white arrows) in the posterior aspect of medulla oblongata near the floor of the fourth ventricle ( known as area postrema), which was hyperintense on T2-W (A and C) and FLAIR (B) sequences with some enhancements on T1-W post gadolinium administration sequence (D) and with no restricted diffusion on DWI (E) and ADC map (F) sequences. The involvement of periventricular white matter (especially in frontal lobes) with extension to subcortical white matter containing few small cysts (black arrows in G and H) and hyperintensity of basal ganglia in caudate heads (white dashed arrows in G). Third-row images belong to follow-up MRI at the age of 8 years including axial and sagittal T2-W (I, J, K) and Axial FLAIR (L); enlargement of the lesion in area postrema (I and J) extending to posterior pons (K) and involvement of bilateral middle cerebellar peduncles and dentate nuclei (white and black arrows in L, respectively)