Examples of MRI changes during severe ICANS. Brain MRI during severe ICANS may rarely demonstrate symmetric T2/FLAIR hyperintensities in dorsal medial thalami (top; arrows) and tectal plate (bottom; arrowheads) resembling imaging changes associated with Wernicke encephalopathy. (A) MRI images from an adult patient with grade 4 ICANS. (B) MRI images from a pediatric patient with grade 4 ICANS. (C) Images from a pediatric patient with diffuse cerebral edema.