case_images: PMC11078538_01
case_images: a Axial MRI brain diffusion-weighted imaging sequence demonstrating multiple foci of restricted diffusion in the hypothalamus at the walls of the third ventricle bilaterally (white arrows), insular cortex bilaterally (red arrows), and pus in the occipital horns of both lateral ventricles (yellow arrows). b Axial MRI brain post contrast T2 FLAIR sequence demonstrating leptomeningeal enhancement at the brainstem (yellow arrows). c Axial MRI brain post contrast T1 fat-saturated sequence demonstrating abnormal enhancement of both oculomotor nerves in the interpeduncular cistern (yellow arrows).
case_images: cop-2024-0015-0001-538821_F01.jpg
case_images: PMC11078538_01_cop-2024-0015-0001-538821_F01.jpg
case_images: F1
case_images: The MRI Brain diffusion-weighted axial sequence demonstrated multiple foci of restricted diffusion and cytotoxic oedema in the cerebral cortex, Sylvian fissures, midbrain, and basal cisterns, with pus in the occipital horns of both lateral ventricles (Fig. 1a). FLAIR sequence (Fig. 1b). Further, there were multiple scattered foci of diffusion restriction in the supratentorial brain and cerebellum, representing acute infarctions. There was enhancement in the interpeduncular cistern, and of both oculomotor nerves, consistent with localised neuritis (Fig. 1c).
case_images: Bilaterally abducted eyes consistent with both bilateral third-nerve palsies as well as WEBINO. The fixed dilated pupils are consistent with bilateral third-nerve palsies.
case_images: cop-2024-0015-0001-538821_F02.jpg
case_images: PMC11078538_01_cop-2024-0015-0001-538821_F02.jpg
case_images: F2
case_images: Both eyes were abducted in the primary position (Fig. 2), a clinical appearance consistent with both bilateral third-nerve palsies and WEBINO.
case_images: a Humphrey visual field (30-2) at 24 weeks demonstrating bilateral tunnel vision. b Macular cube ganglion cell analysis on optical coherence tomography (OCT) demonstrating reduced ganglion cell layer thickness. c OCT nerve fibre layer analysis demonstrating bilateral reduced retinal nerve fibre layer thickness.
case_images: cop-2024-0015-0001-538821_F03.jpg
case_images: PMC11078538_01_cop-2024-0015-0001-538821_F03.jpg
case_images: F3
case_images: By 24 weeks, the patient's visual acuity had improved to 6/6 in both eyes, but the visual fields demonstrated persisting tunnel vision (Fig. 3a).