A 33-year-old man presented with sudden and progressive changes in consciousness after prolonged voluntary food starvation.A, Axial FLAIR (11000/140/2.

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High-signal-intensity lesions on T2-weighted MR images

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Presentation transcript:

A 33-year-old man presented with sudden and progressive changes in consciousness after prolonged voluntary food starvation.A, Axial FLAIR (11000/140/2 [TR/TE/NEX]) image shows marked hyperintensity of the tectal region (white arrows), periaqueductal area (b... A 33-year-old man presented with sudden and progressive changes in consciousness after prolonged voluntary food starvation.A, Axial FLAIR (11000/140/2 [TR/TE/NEX]) image shows marked hyperintensity of the tectal region (white arrows), periaqueductal area (black arrowheads), and mamillary bodies (white arrowheads). The lesions are compatible with reversible cytotoxic edema.B, On sagittal T1-weighted (530/13/2 [TR/TE/NEX]) image, low signal intensity areas with respect to the pons of both periaqueductal areas (black arrowheads) and tectal plate (white arrowheads) are seen. Note that the local swelling determines mild stenosis of the cerebral aqueduct.C, Ten days after thiamine replacement, a partial regression of the lesions involving the aqueductal region (black arrowheads) and mamillary bodies (white arrowheads) is easily seen on axial FLAIR image.D, This finding is confirmed by a sagittal T1-weighted image showing reopening of the cerebral aqueduct (white arrowheads). G. Zuccoli et al. AJNR Am J Neuroradiol 2007;28:1328-1331 ©2007 by American Society of Neuroradiology