Differential diagnosis of a vanishing brain space occupying lesion in a child

Figure 1 Cranial magnetic resonance imaging brain (on admission at September 2009) showing (A, B) sagittal and axial T1-weighted views with a solitary hypointense lesion in the left temporal lobe; (C-E) axial fluid attenuated inversion recovery and T2-weighted (F) images showing hyperintense lesion in the left temporal lobe encroaching on the adjacent brainstem with perifocal edema and mass effect; (G, H) axial and sagittal T1-weighted views showing homogenous solitary enhanced lesion in the left temporal lobe encroaching on the adjacent brainstem and surrounded by a moderate hypointensity.

Figure 2 Cranial magnetic resonance imaging brain (September 2010) showing (A, B) normal axial and sagittal TIW and (C) axial T2W images but (D) hyperintense lesion in the antero-medial region of the left temporal lobe (white arrow) in fluid attenuated inversion recovery image.

Figure 3 Cranial magnetic resonance imaging brain (August 2012) showing (A, B) hyperintense lesion in the antero-medial region of the left temporal lobe (white arrow) in axial fluid attenuated inversion recovery images (white arrow) and (C, D) normal diffusion weighted axial images.

Figure 4 Cranial magnetic resonance imaging and magnetic resonance spectroscopy (MRS) brain (October 2014) showing (A, B) hyperintense lesion in the antero-medial region of the left temporal lobe in axial and coronal fluid attenuated inversion recovery images (white arrow); and (C) no restricted diffusion in axial diffusion weighted axial images; (D, E) long and short time echo MRS showing reduced values of Cho/Cr (long ET = 0. 05; short ET = 0.907), NAA/Cr (long ET = 1.31; short ET = 1.107) and NAA/Cho (long ET = 0.037; short ET = 0.38) ratios. NAA: N-acetyl-aspartate; Cr: Creatine; Cho: Choline.