PMC3959032_01
(a) Right fundus montage showing subhyaloid hemorrhage in boat-shaped pattern with multiple blotch hemorrhages and grade-1 hypertensive retinopathy changes. (b) Left fundus showing grade-1 hypertensive retinopathy changes with absence of intraocular hemorrhages
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F1
Fundoscopy showed boat-shaped subhyaloid hemorrhage involving the posterior pole extending below the inferior arcade, with multiple hemorrhages seen around the normal optic disc in the right eye [Figure 1a] and normal left fundus [Figure 1b], with evidence of bilateral grade-1 hypertensive retinopathy [Figure 1].
Ultrasonography of abdomen showing bilateral renal illdefined multiple (>6) cysts and calculi
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F2
Ultrasonography (USG) of abdomen showed bilateral renal ill-defined multiple (>6) cysts and calculi [Figure 2].
(a) Cranial magnetic resonance imaging showing minimal subarachnoid hemorrhage in the anterior inter-hemispheric fissure and adjacent cortical sulci with edema in adjacent frontal lobes, and hyperacute subdural hemorrhage in bilateral fronto-temporo-parietal regions along the cerebral convexities (5 mm), with no mass effect or midline shift. (b) Magnetic resonance angiography showing a small aneurysm (6 x 6 x 4 mm) arising from the anterior communicating artery, with the neck of aneurysm measuring 1.5 mm in medio-lateral direction
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F3
Cranial magnetic resonance imaging (MRI) revealed minimal SAH in the anterior inter-hemispheric fissure and adjacent cortical sulci with edema in adjacent frontal lobes, and hyper-acute SDH in bilateral fronto-temporo-parietal regions along the cerebral convexities (5 mm), with no mass effect or midline shift [Figure 3a], confirming the diagnosis of TS. Cerebral angiography showed small bi-lobed aneurysm (6 x 6 x 4 mm) arising from the ACoA with the neck of aneurysm measuring 1.5 mm in medio-lateral direction [Figure 3b].
(a) Right fundus montage showing complete resolution of subhyaloid hemorrhage with resolving blotch hemorrhages, a week following Nd:YAG laser photocoagulation. (b) Cranial computed tomography showing near-complete resolution of intracranial hemorrhages with mild enlargement of lateral and third ventricles
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F4
A week later, near-complete resolution of subhyaloid hemorrhage [Figure 4a] and ICH, with mild ventriculomegaly [Figure 4b] was noted.