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Figure 2: A case of rapidly progressive cognitive decline in a 23-year old man. (a) Axial FLAIR image showing asymmetric periventricular confluent white matter hyperintensities; (b) T1 axial pre-contrast image; (c) T1 axial post gadolinium image showing parenchymal enhancement (arrow); (d) susceptibility weighted image showing multiple lobar and subcortical micro bleeds (arrows); (e) DSA showing normal proximal and distal arterioles on left ICA injection; and (f) left frontal meningo-cortical biopsy showing fibrinoid necrosis of parenchymal vessel wall within a focus of infarcted brain tissue (Hematoxylin and eosin stain, original magnification ×250) FLAIR- Fluid attenuation inversion recovery, ICA- internal carotid artery

Figure 2: A case of rapidly progressive cognitive decline in a 23-year old man. (a) Axial FLAIR image showing asymmetric periventricular confluent white matter hyperintensities; (b) T1 axial pre-contrast image; (c) T1 axial post gadolinium image showing parenchymal enhancement (arrow); (d) susceptibility weighted image showing multiple lobar and subcortical micro bleeds (arrows); (e) DSA showing normal proximal and distal arterioles on left ICA injection; and (f) left frontal meningo-cortical biopsy showing fibrinoid necrosis of parenchymal vessel wall within a focus of infarcted brain tissue (Hematoxylin and eosin stain, original magnification ×250) FLAIR- Fluid attenuation inversion recovery, ICA- internal carotid artery