Blood–retina-barrier disruption accompanying blood–brain-barrier dysfunction in posterior reversible encephalopathy syndrome

Abstract

Blood-brain-barrier dysfunction is well known to accompany hypertensive posterior reversible encephalopathy syndrome (PRES) and is considered as the culprit of vasogenic edema and cerebral hemorrhage observed as part of this syndrome. An 84-year-old female was admitted with a diagnosis of PRES in the setting of malignant hypertension. The clinical course was further complicated by ischemic stroke and seizures. Contrast enhanced fluid attenuated inversion recovery (FLAIR) studies revealed diffuse enhancement within the subarachnoid space extending to regions without evidence of cytotoxic or vasogenic edema. These findings suggestive of increased permeability were not only confined to the blood-brain-barrier, but also involved the blood-retina-barrier interface. Our observations suggest that pathologic conditions that disrupt the integrity of blood-brain-barrier might concomitantly affect retinal microcirculation, which highly resembles cerebral microcirculation both anatomically and functionally. Imaging modalities sensitive for detection of blood-brain-barrier dysfunction, such as contrast enhanced FLAIR, might be helpful in identifying these abnormalities.