Fig. 2

A 9-year-old male known leukemic patient was on day 11 of his chemotherapy regimen (IV vincristine, IV doxorubicin, IV l-asparaginase, oral prednisone and intrathecal methotrexate, hydrocortisone, ARA C) when he presented with headache and convulsions. Brain MRI was done on the same day of clinical presentation. MRI revealed: FLAIR (a–c) showed bilateral almost symmetrical (except at cerebellum it is asymmetrical) predominantly subcortical areas of abnormally high signal intensity are seen in the occipital lobe (b), frontal (a), parietal lobes (a) and left cerebellar hemisphere (black arrows). No sizable areas of hemorrhage were seen. DWI (d): The lesion in the left cerebellar hemisphere showed high signal (black arrowhead). ADC map (e): The lesions show isointense signal compared to the contralateral normal brain parenchyma denoting pseudonormalization phenomenon (white arrowhead). There was no appreciable contrast enhancement (not shown). The MRI findings are consistent with an atypical MRI pattern of PRES with grade II edema extension. Follow-up MRI study of the brain after 2 months which showed complete resolution of all lesions