A 71-year-old right-handed woman with chronic kidney disease who presented with repetitive episodes of altered mental status. These episodes were described as incoherent speech and version of head and eyes to the right, followed by loss of awareness.

Initial MRI imaging of brain, with and without 20 ml of Gadolinium (Gad) contrast, at the time of admission did not show any acute pathology. EEG monitoring showed repetitive seizures arising from left fronto-central region, consistent with focal status epilepticus (SE).  She required three antiepileptic drugs, namely Levetiracetam, Fosphenytoin and Valproic acid to stop the seizures. Repeat MRI with Gad contrast, two days after the first MRI showed subarachnoid hyper intensity on FLAIR sequence, over the left parietal and frontal convexity with no corresponding changes on diffusion weighted imaging (DWI), gradient echo (GRE) or postcontrast T1-weighted imaging. This pattern was reported by radiologist as concerning for subarachnoid blood. This finding was perplexing, as the CT head at that time did not show any evidence of bleeding.

Lumbar puncture was largely unremarkable with white blood cell count of 4/uL, zero RBCs, no Xanthochromia, and a mildly elevated protein at 61 mg/dl. Meningitis panel and cultures were negative. A third follow up MRI brain with and without Gad contrast, seven days after the second MRI showed a complete resolution of previously mentioned FLAIR findings.