case_images: PMC4711040_01
case_images: Panels A to E reveal the MRI of patient 1. A and B, axial sections of T2-weighted images (T2WI); C, mid-sagittal plane of T2WI; D and E, coronal sections of T1WI and T2WI, respectively; F, MR spectroscopy of voxel at subcortical white matter. MRI shows white matter changes in subcortical region diffusely, seen as hypointense and hyperintense signal on T1WI and T2WI, respectively. There is sparing of central white matter. There is also T2-hyperintense signal at bilateral dentate nuclei (panel A).
case_images: 40734_2014_9_Fig1_HTML.jpg
case_images: PMC4711040_01_40734_2014_9_Fig1_HTML.jpg
case_images: Fig1
case_images: There was no null point or geste antagoniste (Figure 1 and Additional file 1). T1 and T2 images, and relative sparing of central white matter. There were also hyperintense signals in both dentate nuclei on T2 images (Figure 1A-E). MR spectroscopy revealed a high lactate peak and reduced N-acetylaspartate to creatine ratio (Figure 1F).
case_images: Handwriting of patient 1, when on trihexyphenidyl 2 mg/day. The upper, middle and lower rows demonstrate handwriting when she was allowed to write with only the right or the left hand, respectively. Her handwriting was worse with the right hand, correlated with the degree of dystonia in each hand.
case_images: 40734_2014_9_Fig2_HTML.jpg
case_images: PMC4711040_01_40734_2014_9_Fig2_HTML.jpg
case_images: Fig2
case_images: The dose was reduced to 2 mg/day (Figure 2).