PMC5409931_01
Brain imaging of patient 1. (A) Magnetic resonance imaging brain scan: small vessel ischemic disease. (B) Fludeoxyglucose positron emission tomography and computed tomography: diffuse moderate left basal ganglia hypometabolism, moderate regional left posterior parietal hypometabolism and mild-moderate left frontal hypo metabolism.
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Magnetic resonance imaging (MRI) of the brain showed small vessel ischemic disease (Figure 1A); MRI of the cervical and thoracic spine was normal and the lumbar sacral spine showed postoperative changes. Fludeoxyglucose (18F) positron emission tomography and computed tomography PET/CT showed diffuse moderate left basal ganglia hypometabolism, moderate regional left posterior parietal hypometabolism, and mild-moderate left frontal hypometabolism (Figure 1B).
PMC5409931_02
Patient 1: Abduction and adduction of the toes on the right side, involuntary dorsiflexion and flexion of the right ankle and myoclonus.. Patient 1: Involuntary movements of the right leg "alien leg". In order for the patient to stand up the doctor had to stand on his right foot to hold it in place.. Patient 1: Right alien leg, magnetism, grasp and stimulus sensitive myoclonus in both hands.. Patient 1: Left alien leg, difficulty putting a shoe on.
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A nuclear magnetic dopaminergic brain scan (DAT scan) showed subtle decreased uptake of tracer in the left posterior putamen (Figure 2A). 18F PET/CT showed reduced metabolic activity in the bilateral insula, perisylvian regions, and midline pre-frontal cortex (Figure 2B).