case_images: PMC11345220_01
case_images: Imaging characteristics at admission and follow-up of this patient. (A) Symmetrical calcification of bilateral basal ganglia and thalamus was showed in head CT at admission; (B) CT urography showed that the left ureteropelvic junction was narrow with left hydronephrosis; (C) No abnormality in the head CTA. (D-F) Showed the cranial MRI T2flair characteristics of this patient at admission, after 1 month and 6 months of follow-up. After admission, only the right occipital cortex showed laminated high signal (D). One month later, the patient showed typical high signal intensity area in the right occipital lobe (E). Six months later, the right occipital lobe lesion disappeared and transferred to the left occipital cortex (F).
case_images: fgene-15-1393158-g001.jpg
case_images: PMC11345220_01_fgene-15-1393158-g001.jpg
case_images: F1
case_images: Emergency head computed tomography (CT) and computerized tomography angiography (CTA) scans revealed high density calcification in the bilateral caudate nucleus, lentiform nucleus, thalamus, and dentate nucleus, but no obvious intracranial stenosis or acute processes were observed (Figures 1A, C). Urinary CT and CT urography suggested a narrow left ureteropelvic junction with left hydronephrosis, which was confirmed by urologists as ureteropelvic junction obstruction (UPJO) (Figure 1B). Head magnetic resonance imaging (MRI) showed symmetric abnormal signals in bilateral basal ganglia (Figure 1D). A 1-month follow-up head MRI was performed, which revealed abnormal signals in the right temporoccipital parietal cortex (Figure 1E). After 6 months, the patient returned for a follow-up visit and a repeat head MRI scan showed that the lesions transferred to the left occipital cortex (Figure 1F), which showed the imaging characteristics of typical MELAS syndrome.
case_images: The video EEG characteristics at the first admission and 1-month follow-up of this patient. (A) Showed typical spine and slow wave distribution (00:15:07), mainly in area of Fp2-F4 and Fp2-F8, and conducted to Fp1-F3 at 222 m, and no clinical onset of the patient was observed (at admission) (Montage:Bipolar longitudinal connection, TR:30 mm/s, Sensitivity:100 muV/cm, HF:40 Hz, LF:1.0 Hz). (B) Showed lateralized periodic discharges (LPD) composed of sharp slow wave, interval cycle: 1.17-1.58 s, mainly in area of O1, no clinical onset of the patient was observed (1 month later) (Montage:Earlobe reference, TR:30 mm/s, Sensitivity:100 muV/cm, HF:70 Hz, LF:1.0 Hz).
case_images: fgene-15-1393158-g002.jpg
case_images: PMC11345220_01_fgene-15-1393158-g002.jpg
case_images: F2
case_images: Continuous EEG monitoring showed scattered in the low-medium-high-ultra-high amplitude spine waves, spine slow waves (Figure 2A). The second follow-up of the video EEG indicated a typical pattern of LPD appeared in the occipital area (Figure 2B).