Reversible Perfusion Changes during Acute Attacks in Glucose Transporter Type 1 Deficiency Syndrome: A Pediatric Case Series

Case 2. MR examinations from left to right: 3D-pCASL, ADC map, MRA-MIP, and SWI. The upper row shows the acute onset: hypoperfusion in the left cerebral hemisphere (white arrow) and in cerebellar hemispheres but more pronounced in the right cerebellar hemisphere (blue arrow). No ADC map changes are seen. Note reduced representation of the distal branches of the left MCA (white arrowhead) and a mild increase in the conspicuity of cortical veins on the left side on SWI (blue arrowhead). The lower row shows the follow-up examination after 3 days, with normalization of all the findings.

Case 3. MR examinations from left to right: 3D-pCASL, ADC map, TOF-MIP, and SWI. The upper row shows the acute phase findings: hypoperfusion of the left cerebral hemisphere (white arrow) and of the contralateral cerebellar hemisphere (blue arrow). No ADC map changes are seen. Note reduced representation of distal branches of the left MCA (white arrowhead) and a mild increase in the conspicuity of cortical veins on the left side on SWI (blue arrowhead). The lower row shows the follow-up examination after 7 days, with normalization of all acute findings. There is persistent-but-improved hypoperfusion of the right cerebellar hemisphere proportional to what would be expected for the known background encephalomalacia in this region (blue arrow).