Teaching NeuroImage: an imaging clue for neuronal intranuclear inclusion disease.

A 56-year-old man with cognitive decline and right hemiparesis for 1 week. Neuroimaging revealed a bilateral high intensity signal in the corticomedullary junction and left temporal lobe on diffusion-weighted imaging (DWI) (figure A and C), a corresponding low signal on ADC (figure B and D), a slightly hyperperfusion in left temporal lobe (figure E) and high-intensity signal in bilateral middle cerebellar peduncles on fluid-attenuated inversion recovery (figure G). Postcontrast magnetic resonance imaging showed enhancement of the left occipito-parietal cortex (figure H). A diagnosis of NIID was established based on skin biopsy and genetic testing. Temporal lobe hyperperfusion, occipito-parietal cortical enhancement and a high signal in bilateral middle cerebellar peduncles may be a diagnostic clue for NIID in patients mimic stroke [1].