Figure 2. Temporal evolution of VWMD in the patient for 17 years. Serial T2-WI scans of a patient with VWMD. Columns A and B show initial and follow-up MRI images obtained at the ages of 12 and 16 years with symptoms of headache and syncope, respectively. Column C shows images obtained after the onset of motor neurological symptoms, such as hand tremor and upper-extremity weakness, at the age of 25 years, and the column D image was obtained at the age of 29 years due to lower-extremity weakness and severe gait disturbance. Changes in the extent of the lesion over time can be seen at the corona radiata, basal ganglia, and pons levels. In column C, the extent of white matter hyperintensity increased at the corona radiata level, and the invasion of the splenium of the corpus callosum was found. At the level of basal ganglia, there is a distinct dark signal intensity due to iron deposition in the globus pallidus and thalamus. At the level of the pons, dark signal intensity was prominent in the dentate nucleus, and white matter hyperintensity was seen in the cerebellar peduncle in column D.