Fig. 1

Radiologic progression of midbrain lesion. (A) Subtle T2/FLAIR-hyperintense lesion (red arrow) seen in retrospect 9 months prior to presentation with neurologic symptoms. (B) Right paramedian midbrain lesion at onset of neurologic symptoms, without contrast enhancement or diffusion restriction. (C-E) Growth of the lesion over 5 months, with gradual development of peripheral diffusion restriction (red arrows) but still no contrast enhancement. (F) FDG-PET shows midbrain lesion (red arrow) is hypometabolic compared to grey matter (*).