case_images: PMC5325914_01
case_images: PMC5325914_02
case_images: Bilateral basal ganglia hyper-intensities on brain magnetic resonance imaging (MRI
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case_images: F1
case_images: Brain magnetic resonance imaging (MRI) showed symmetric bilateral hypersignal lesions in basal ganglia accompanied by isosignal lesions in splenium and corpus callossum (Figure1).
case_images: Restriction of the lesions on diffusion weighted (DW) brain magnetic resonance imaging(MRI
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case_images: F2
case_images: Basal ganglia lesions were negative on diffusion weighted (DW) while splenium and corpus callossum were positive, restricted with low apparent diffusion coefficient (Figure 2).
case_images: Reduced amplitude of the right and left median motor nerves on nerve conduction velocity (NCV
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case_images: F3
case_images: Magnetic resonance spectroscopy also reported an abnormal hyper intensity with near symmetrical configuration in periventricular region, brain stem and medulla with lactate rise and diffusion restriction compatible with mitochondrial disorders or glutaricaciduria.Electromyography/nerve conduction velocity (EMG/NCV) revealed axonal polyneuropathy with neurogenic changes without active denervation (Figure 3).