PMC2779317_01
(A) Left lateral gaze and (B) Right lateral gaze. This patient shows marked bilateral limitation of adduction not crossing midline (arrows), but no limitation of abduction, elevation and depression in eyeball movement.
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F1
An ophthalmic examination showed medial gaze disturbance of the both eyeballs (Fig. 1), but reduction of visual power, visual field defect, and optic disc abnormality were not detected.
(A) Sagittal T2-weighted MR image of the brainstem and the spinal cord before treatment. This image shows generalized multifocal high signal intensities involving midbrain, pons, medulla and whole spinal cord longitudinally. (B) This T2-weighted MR image after one month shows decrease in the previous high signal intensities in the midbrain, pons, medulla, and cervical spinal cord. However, more increased high signal intensities and distorted conus medullaris are seen in the thoracic and lumbar spinal cord.
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F2
An MRI scan of the brain and whole spine showed a diffuse swelling and high signal intensities involving the whole spinal cord, pons, and medulla oblongata (Fig. 2A). However, remnant and worsened abnormal changes in the thoracic spinal cord extending to the conus medullaris were identified (Fig. 2B, 3B).
(A) T2-weighted brain MR image before treatment. This image shows nodular high signal intensity in periaqueductal region of the midbrain (arrow). (B) This follow up image after treatment shows decrease in the previous high signal intensities in periaqueductal region of the midbrain (arrow).
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F3
Bilateral high signal intensities in T2-weighted image were pronounced in the lower midbrain, pons, medulla oblongata, and periaqueductal region (Fig. 3A). However, remnant and worsened abnormal changes in the thoracic spinal cord extending to the conus medullaris were identified (Fig. 2B, 3B).