case_images: PMC10646415_01
case_images: Abdominal computed tomography (CT) images and family tree. (A) Simple CT image of the abdomen: Intracystic hemorrhage in the right kidney. (B) Enlarged view of the square in (A) Arrows indicate intracystic hemorrhage. (C) Contrast-enhanced CT image of the abdomen. Numerous cysts of various sizes are present in both kidneys. (D) Family tree, with symbols of autosomal dominant polycystic kidney disease-affected individuals painted in black. ADHD, attention deficit hyperactivity disorder; ASD, autism spectrum disorder; Epi, epilepsy.
case_images: fped-11-1283823-g001.jpg
case_images: PMC10646415_01_fped-11-1283823-g001.jpg
case_images: F1
case_images: The patient's father was also on dialysis. (Figure 1).
case_images: Course of treatment and objective/subjective parameters. (A) Average pain numerical rating score (NRS). (B) EuroQoL-5 Dimension. (C) Hospital Anxiety and Depression Scale. (D) Pain Catastrophizing Scale and blood pressure and heart rate. ADPKD, autosomal dominant polycystic kidney disease; ATX, atomoxetine; D, day; EQ-5D, euro QoL 5 Dimension; GF, guanfacine; HADS-A/D, Hospital Anxiety and Depression Scale-Anxiety/Depression; MP, methylphenidate; NRS, numerical rating scale; PCS, Pain Catastrophizing Scale; SPECT, single-photon emission computed tomography.
case_images: fped-11-1283823-g002.jpg
case_images: PMC10646415_01_fped-11-1283823-g002.jpg
case_images: F2
case_images: Changes in conners 3 scores during the Course of treatment. (A) Conners 3-Self Report (B) Conners 3-Parent. ADHD, Attention-Deficit/Hyperactivity Disorder; GI, Global Index.
case_images: fped-11-1283823-g003.jpg
case_images: PMC10646415_01_fped-11-1283823-g003.jpg
case_images: F3
case_images: ADHD symptoms were assessed using the Conners 3-self-report and -parent assessment, completed by the patient and her mother, respectively (Figure 3). According to the results, her subscale scores exceeded 65 points and her ADHD symptoms were at the clinical psychiatric level (Figure 3).
case_images: Changes in cerebral blood flow during the course of treatment. (A) Brain perfusion single-photon emission computed tomography images obtained on day 96 before initiating ADHD medications (B) Pain-free status on day 292 under administration of atomoxetine (50 mg/day). (C) A persistent pain-free status on day 1,503 is achieved with a combination of methylphenidate (18 mg/day) and guanfacine (4 mg/day). The three axial images from left to right indicate the inferior frontal, basal ganglia, and frontoparietal levels. The squared area on the axial images of the basal ganglia level in (A) and (C) are expanded in (D) and (E), respectively, to show a magnified view of the insular cortex area. The voxel values are normalized by the average counts-per-voxel with the cerebellum being 50; the color bar represents from 5 to 65. Mild hypoperfusion in the bilateral prefrontal cortices in (A) are slightly increased in (B) and returned to a similar level as (A) in (C) (white dashed curves). The insular cortex is identified in (D) (arrows), but not in (E), suggesting that the relative hyperperfusion in (D) is reduced in (E) The mean normalized voxel values for each image from (A) to (C) are as follows: 48.4, 50.1, and 48.5 in the prefrontal region and 54.3, 53.6, and 52.4 in the insular cortex, respectively. 99mTc- ethyl cysteinate dimer (ECD; Fujifilm RI Pharma, Tokyo, Japan) at a dose of 740 MBq is administered to the patient resting in a supine position in a quiet room with her eyes closed. Approximately 10 min after injection, SPECT is performed for 30 min with a triple-head gamma camera (GCA-9300R; Canon Medical Systems Corp, Tochigi, Japan). Voxel value normalization and calculation are performed using PMOD version 3.7 (PMOD Technologies Ltd., Zurich, Switzerland). SPECT: single-photon emission computed tomography; ADHD, attention deficit hyperactivity disorder.
case_images: fped-11-1283823-g004.jpg
case_images: PMC10646415_01_fped-11-1283823-g004.jpg
case_images: F4
case_images: Mild hypoperfusion of the frontal lobe and relative hyperperfusion of the insular cortex were observed (Figure 4).