case_images: PMC10978580_01
case_images: Patient 1 images (A) The cranial MR T2 FLAIR image shows no obvious abnormal findings except for mild atrophy of the bilateral parietal lobes. (B) I-123IMP SPECT shows reduced cerebral perfusion in the bilateral parietal, temporal, and occipital lobe while perfusion in the bilateral posterior cingulate cortex was relatively preserved. (C) I-123FP-CIT SPECT showed a decrease in accumulation of dopamine in the striatum. (D, E) These images show the environmental triggers associated with the visual hallucinations. Cushions on a sofa in the living room (D), the pattern on a carpet under the table in the living room (E) were suspected of inducing her visual hallucinations as follows: "Boy sitting on the sofa" and "Child playing under the table," respectively. (F, G) These images show the living environment post-intervention. The carpet pattern was hidden by a tablecloth (F), and the clothes on hangers in the bedroom were stored in a closet (G).
case_images: fpsyt-15-1283156-g001.jpg
case_images: PMC10978580_01_fpsyt-15-1283156-g001.jpg
case_images: f1
case_images: Cranial magnetic resonance (MR) imaging showed no obvious abnormalities except for mild atrophy of the bilateral parietal lobes ( Figure 1A ). 123I-IMP single-photon emission computed tomography (SPECT) revealed reduced cerebral perfusion in the bilateral parietal, temporal, and occipital lobes, while perfusion in the bilateral posterior cingulate cortex was relatively preserved ( Figure 1B ). 123I-FP-CIT SPECT revealed reduced accumulation in the right-dominant bilateral posterior striatum ( Figure 1C ). Figures 1D, E ). For instance, cushions on a sofa in the living room, a pattern on a carpet under the table in the living room, and clothing on hangers in the bedroom (not visible in the PA-LE) were associated with instances of VH ("Boy sitting on the sofa," "Child playing under the table," and "Someone is in my bedroom," respectively), although the VH did not occur every time she saw the triggers. Her husband implemented the guidance provided, and the environmental triggers were reduced ( Figures 1F, G ).
case_images: PMC10978580_02
case_images: Patient 2 images (A) The cranial MR T2 FLAIR image shows bilateral atrophy of the medial temporal lobe with an extensive high intensity area. (B) I-123IMP SPECT shows diffuse reduction of brain perfusion. (C-E) These images show the environmental triggers associated with the visual hallucinations. Clothing on hangers in the bedroom (C), dolls in the bedroom (D), and dolls in the living room (E) were suspected of inducing her visual hallucinations as follows: "Male strangers intruded my home from the balcony", or "Children looked for something in the chest of drawers". (F-H) These images show the living environment post intervention. The clothes on hangers were removed (F), the dolls in the bedroom were hidden using blindfold shades (G), and the number of dolls in the living room was reduced (H).
case_images: fpsyt-15-1283156-g002.jpg
case_images: PMC10978580_02_fpsyt-15-1283156-g002.jpg
case_images: f2
case_images: Cranial MR revealed bilateral atrophy of the medial temporal lobe and extensive high-intensity areas in the periventricular region and deep white matter ( Figure 2A ). 123I-IMP SPECT revealed an extensive reduction of brain perfusion ( Figure 2B ). VH several times daily in the living room and bedroom ( Figures 2C-E ). VH mainly occurred in the evening and at night. Her daughter implemented the provided guidance, and the environmental triggers were reduced ( Figures 2F-H ).