A 64-year-old man presenting MRIs of expansive multiple high intensity areas in the cerebral white matter, cerebellum and brainstem

A 64-year-old man, who had been suspected as a hepatitis carrier 25 years ago and also was detected with a decrease of leukocytes and lymphocytes in the previous year, visited our hospital on 31 January, because of vertigo. Neurological status revealed normal findings. Blood cell count disclosed 4200 WBCs with a differential count of 66% segmented neutrophils, 8% non-segmented neutrophils, 10% lymphocytes, 14% monocytes, 1% eosinophiles and 1% basophiles. HBs Ag and HCV Ag were negative. T2-weighted brain MRI showed small high intensity areas (HIAs) in the left occipital white matter (Fig. 1a) and the midbrain tegmentum. He was admitted for 20 days as having cerebral infarcts. Anticoagulant therapy was effective. He was readmitted because of paralysis of the left leg 2 months after discharge. MRI showed a new HIA in the convolutional white matter of the right motor area. Anticoagulant therapy and rehabilitation were effective. He was admitted at the 3rd time on 3 July, because of worsened weakness of the left leg. On MRI examination HIA in the motor area spread and a small HIA was revealed in the right frontal white matter. Left hemiparesis was progressive. Mental retardation, visual disturbance and emotional instability developed. In September he was suspected as having vascular dementia or some degenerative condition in the cerebral white matter as well as cerebral infarcts. MRI examination revealed widespread HIAs in the brainstem, cerebellar white matter, thalamus and cerebral white matter (Fig. 1b). He died in December. The duration of the present illness was 11 months after his first visit to our hospital.