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BackgroundComitant exotropia (CE) is a common eye movement disorder, characterized by impaired eye movements and stereoscopic vision. CE patients reportedly exhibit changes in the central nervous system. However, it remains unclear whether large-scale brain network changes occur in CE patients.PurposeThis study investigated the effects of exotropia and stereoscopic vision dysfunction on large-scale brain networks in CE patients via independent component analysis (ICA).MethodsTwenty-eight CE patients (mean age, 15.80 ± 2.46 years) and 27 healthy controls (HCs; mean age, 16.00 ± 2.68 years; closely matched for age, sex, and education) underwent resting-state magnetic resonance imaging. ICA was applied to extract resting-state networks (RSNs) in both groups. Two-sample’s t-tests were conducted to investigate intranetwork functional connectivity (FC) within RSNs and interactions among RSNs between the two groups.ResultsCompared with the HC group, the CE group showed increased intranetwork FC in the bilateral postcentral gyrus of the sensorimotor network (SMN). The CE group also showed decreased intranetwork FC in the right cerebellum_8 of the cerebellum network (CER), the right superior temporal gyrus of the auditory network (AN), and the right middle occipital gyrus of the visual network (VN). Moreover, functional network connectivity (FNC) analysis showed that CER-AN, SMN-VN, SN-DMN, and DMN-VN connections were significantly altered between the two groups.ConclusionComitant exotropia patients had abnormal brain networks related to the CER, SMN, AN, and VN. Our results offer important insights into the neural mechanisms of eye movements and stereoscopic vision dysfunction in CE patients.

Introduction. Glioblastoma multiforme (GBM), the most common primary malignant brain tumor in adults, is characterized by extensive heterogeneity in its clinicopathological presentation. A primary brain tumor with both astrocytic differentiation and neuronal immunophenotype features is rare. Here, we report a long-term survival patient who presented this rare form of GBM in the disease course. Presentation of Case. A 23-year-old woman, presenting with rapidly progressive headache and right-side weakness, was diagnosed with brain tumor over the left basal ganglion. She underwent the first craniectomy for tumor removal, and histopathology revealed classic GBM. Tumor recurrence occurred 8 years later. Another gross total resection was performed and pathology revealed GBM with the oligodendroglioma component (GBM-O). Due to disease progression, she received debulking surgery the following year. The third pathology revealed glioblastoma with primitive neuroectodermal tumor-like component (GBM-PNET). Discussion. GBM-PNETs are collision tumors with both neuronal and glial components. They are rare, and a few case reports have suggested that these tumors are associated with favorable outcomes but a higher risk of cerebrospinal fluid dissemination. Conclusion. We report a patient who developed the distinct pathologic variants of classic GBM, GBM-O, and GBM-PNET, throughout the disease course. Young age, aggressive surgical resection, and pathologic and genetic features may have contributed to the long-term survival of the patient.