PMC9125146_01
(A) Electroencephalography findings: Severe abnormal diffuse mixed slow waves with a lot of fast waves, intermittent low-voltage waves, lasting about 1s, diffuse 1-2Hz irregular s activity, left sharp waves and sharp slow waves are emitted from the front side of the head; (B) Head MRI - T2 FRFSE: Bilaterally symmetrical abnormal signals are observed in the anterior cingulate gyrus; (C) Head MRI - T2 FLAIR sequence: Symmetrical abnormal signals of insula and fronto temporal lobes; (D) Fundus examination: Both eyes have clear cornea with no hyperemia, anterior chambers, pupil diameter of ~3mm, slow reflection of light; (E) Ophthalmic ultrasound-L: (1) Severe vitreous opacity; (2) Thickening of the posterior wall of eyeball; (3) Thickening of the four rectus muscles of the eyes; (F) Ophthalmic ultrasound-R: (1) Severe vitreous opacity; (2) Thickening of the posterior wall of eyeball; (3) Thickening of the four rectus muscles of the eyes. The ring of the right eye is intact, the lens wave is visible, and the dark area can be seen in the vitreous body. There is medium to high amount of diffuse flocculent weak echo and cluster echo. The posterior wall of the ball is thickened and slightly rough. The thickness of the superior rectus, external rectus, inferior rectus, and medial rectus is ~5.9, 5.6, 5.6, and 6.4mm, respectively.
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F1
Electroencephalography (EEG) showed abnormal findings (Figure 1A). Brain magnetic resonance imaging (MRI) revealed intense T1 and T2 signal changes in the anterior cingulate gyrus, insula, and frontotemporal lobes (Figures 1B,C). Fundus examination showed sluggish light reflex in both eyes (Figure 1D). Ophthalmic ultrasound showed severe vitreous opacity in both eyes (Figures 1E,F).
(A) Ophthalmology wide-angle lens examination-L; (B) Ophthalmic Ultrasound-left: The left eye ring is intact, the lens wave is visible, and the dark area of the vitreous body is moderately diffuse. Spot flocculent weak echo and mass echo, and the posterior wall of the ball is slightly thickened. There is no obvious thickening of the four rectus muscles. (C) Ophthalmology wide-angle lens examination-R; (D) Ophthalmic Ultrasound-right: The right eye ring is intact, the lens wave is visible, and low and medium amount of diffuse spot flocculent weak echo and cluster echo are seen in the dark area of the vitreous body. Both the horizontal axis and the vertical axis can be detected in the vitreous "shaped echo" band echo. The tip is connected with the optic papilla, and the two ends are connected with the peripheral spherical wall.
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F2
Repeat ophthalmological ultrasound showed moderate vitreous opacity in both eyes (more obvious in the left eye), mild thickening of the posterior wall of both eyes, and total retinal detachment in the right eye (Figure 2). Ophthalmology wide-angle lens examination was performed to assess the risk of surgery (Figure 2).
(A) EEG examination: moderate to severe abnormal EEG, background diffuse 0, 6 slow wave bursts, 7-8 Hz slow rhythm bursts in the occipital lobe; (B) Head MRI - T1IR-TSE: normal head size, bilateral frontal lobe, temporal lobe, insula, bilateral hippocampus, bilateral thalamus, bilateral cingulate gyrus, flaky T1 low signal; (C) Head MRI - T2 FLAIR sequence: head size is normal; temporal lobe, insula, and bilateral hippocampus present high signal in T2 FLAIR, high signal in FLAIR; local sulci are clearer than before; (D) Fundus examination-left eye; (E) Ophthalmic ultrasound-L: severe vitreous opacity, mild thickening of the posterior wall of the eyes; (F) Ophthalmic ultrasound-L: severe vitreous opacity, mild thickening of the posterior wall of the eyes, thickening of the inner rectus muscle of the right eye.
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F3
Visual acuity examination (left: 0.15, right: 0.1 x 0.5/5 = 0.01) (Figures 3D-F). On follow-up examination 48 days after discharge, the patient was able to walk slowly on his own without support (Figure 3A). Repeat head MRI (Figures 3B,C) showed few changes compared with the previous MRI; the local swelling was reduced, and the degree of brain atrophy was aggravated.