Visual vignettes describing development of paresis in 4 patients with spinal cord abnormalities on neuroimaging. Patient 1: (A) Time line of clinical course. (B) Axial FLAIR images from MRI of the brain showing bilateral, symmetric white matter changes (thick white arrows) with restricted diffusion (diffusion-weighted images not shown). (C) Axial (left) and sagittal (right) T2 images from MRI of the spine showing increased T2 signal in dorsal columns through entire cord (thin red arrows), without enhancement (enhanced images not shown). Patient 2: (D) Time line of clinical course. (E) Axial FLAIR images from MRI of the brain showing changes in the subcortical, deep, and periventricular cerebral white matter (thick white arrows). (F) Axial (left) and sagittal (right) T2 images from MRI of the spine showing increased T2 signal in dorsal columns through entire cord (thin red arrows), without enhancement (enhanced images not shown). Patient 3: (G) Time line of clinical course. (H) Axial FLAIR images from MRI of the brain showing symmetric foci of T2 hyperintensity involving supratentorial white matter (thick white arrow) and brainstem. (I) Axial (left) and sagittal (right) T2 images from MRI of the spine showing diffuse hyperintensity throughout the entire cord, from the brainstem to the conus (thin red arrows), without enhancement (gadolinium-enhanced images not shown). (J) Axial FLAIR images from MRI of the brain showing interval reduction in T2 signal abnormalities from prior study (thin white arrow). (K) Axial (left) and sagittal (right) T2 images from MRI of the spine showing interval progression of mildly expansile T2 hyperintense signal involving most of the spinal cord. Patient 4: (L) Time line of clinical course. (M) Axial FLAIR images from MRI of the brain showing nonspecific nonenhancing white matter T2/FLAIR hyperintensities (thick white arrows). (N) Sagittal T2 image from MRI of the spine showing extensive, patchy, nonenhancing multifocal T2 lesions, some of which were expansile (thin white arrows; contrast images not shown). D/C, discharge; DTR, deep tendon reflex; IVIG, intravenous immunoglobulin; PICU, pediatric intensive care unit; rehab, rehabilitation; WBC, white blood cell.

Visual vignettes describing development of paresis in 4 patients with spinal cord abnormalities on neuroimaging. Patient 1: (A) Time line of clinical course. (B) Axial FLAIR images from MRI of the brain showing bilateral, symmetric white matter changes (thick white arrows) with restricted diffusion (diffusion-weighted images not shown). (C) Axial (left) and sagittal (right) T2 images from MRI of the spine showing increased T2 signal in dorsal columns through entire cord (thin red arrows), without enhancement (enhanced images not shown). Patient 2: (D) Time line of clinical course. (E) Axial FLAIR images from MRI of the brain showing changes in the subcortical, deep, and periventricular cerebral white matter (thick white arrows). (F) Axial (left) and sagittal (right) T2 images from MRI of the spine showing increased T2 signal in dorsal columns through entire cord (thin red arrows), without enhancement (enhanced images not shown). Patient 3: (G) Time line of clinical course. (H) Axial FLAIR images from MRI of the brain showing symmetric foci of T2 hyperintensity involving supratentorial white matter (thick white arrow) and brainstem. (I) Axial (left) and sagittal (right) T2 images from MRI of the spine showing diffuse hyperintensity throughout the entire cord, from the brainstem to the conus (thin red arrows), without enhancement (gadolinium-enhanced images not shown). (J) Axial FLAIR images from MRI of the brain showing interval reduction in T2 signal abnormalities from prior study (thin white arrow). (K) Axial (left) and sagittal (right) T2 images from MRI of the spine showing interval progression of mildly expansile T2 hyperintense signal involving most of the spinal cord. Patient 4: (L) Time line of clinical course. (M) Axial FLAIR images from MRI of the brain showing nonspecific nonenhancing white matter T2/FLAIR hyperintensities (thick white arrows). (N) Sagittal T2 image from MRI of the spine showing extensive, patchy, nonenhancing multifocal T2 lesions, some of which were expansile (thin white arrows; contrast images not shown). D/C, discharge; DTR, deep tendon reflex; IVIG, intravenous immunoglobulin; PICU, pediatric intensive care unit; rehab, rehabilitation; WBC, white blood cell.

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