case_images: PMC10799339_01
case_images: Clinical ophthalmologic symptoms. Bilateral ptosis (A) and external ophthalmoplegia with paralysis of vertical movements (B).
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case_images: F1
case_images: The diagnosis of KSS was supported by identifying relevant clinical characteristics that indicated an abnormality in the patient's ophthalmologic system: bilateral ptosis, diplopia, chronic progressive external ophthalmoplegia, and a moderate decrease in visual acuity (Figure 1A). Paralysis of the vertical movements of the eyeballs was observed (Figure 1B).
case_images: ECG-first-degree atrioventricular block, major right bundle branch block, and sinus tachycardia.
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case_images: F2
case_images: Conduction abnormalities were seen, including first-degree atrioventricular block (AVB), significant right bundle branch block (RBBB), and sinus tachycardia (Figure 2).
case_images: Upon admission to the hospital, MRI brain scans with contrast revealed T2 axial hypersignal in the subcortical white matter of both temporal lobes (A) and in the bilateral insula of the Reil lobes (B). MRI stands for magnetic resonance imaging.
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case_images: F3
case_images: The results revealed symmetrical high-T2 and Flair signals in the cerebral white matter of both temporal lobes and in the bilateral insula of the Reil lobes (Figure 3).
case_images: MRI axial Flair FSE images without contrast demonstrated abnormally high signals in the bilateral temporal lobes (A) and in the bilateral insula of the Reil lobes (B) MRI T2 axial images without contrast showed hypersignal in bilateral temporal lobes (C) and cerebellar white matter (D); imaging appearance was unchanged after 6 months. MRI, magnetic resonance imaging; Flair, fluid attenuated inversion recovery; FSE, fast spin echo.
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case_images: F4
case_images: Figure 4 shows the presence of cerebellar atrophy.