Fig. 2

This is a set of brain MRI images of a 7 year old boy who suffered cerebral malaria at the age of 4 years. On discharge he only had hyperreflexia. His neurologic examination 3 years later was normal but the mental health assessment demonstrated oppositional defiant disorder. The brain MRI had bilateral wide spread punctate T1 weighted (T1W) hypointensities (a) and T2W hyperintensities (b) and (c) in the white mater and most marked in the parietal and temporal areas. There are associated with periventricular hyperintensities around the posterior horns of the lateral ventricles the largest of which measures 6 mm and widening of the sulcal spaces in the frontal and parietal lobes. The lesions exhibit no diffusion restriction on diffusion weighted imaging (DWI), (d). The changes suggest bilateral wide spread small vessel ischemia and cerebral atrophy. T1W T1 weighted imaging, T2W T2 weighted imaging, DWI diffusion weighted imaging