Sudden bilateral vision loss and binasal campimetric involvement in an unusual case of lateral geniculate myelinolysis

Abstract

AbstractPurpose Central pontine myelinolysis, a devastating demyelinating disease, is thought to be caused by an aggressive correction of a hyper‐ or hypo‐osmolar state. Lateral geniculate nucleus (LGN) has been incidentally found to be affected by an extrapontine demyelination on magnetic resonance imaging (MRI), although visual disturbances implicating both LGNs are unusual. We describe a campimetric involvement secondary to an intrageniculate damage.Methods A 40‐year‐old man, who was diagnosed with pancreatitis following cholecystectomy, complained of bilateral acute vision loss. His best corrected visual acuity (BCVA) was counting fingers in the right eye and 20/200 in the left eye. Optical coherence tomography (OCT) showed a slightly increased macular thickness in the nasal region of both eyes as well as an altered reflectivity of the retinal layers. Automated perimetry revealed a binasal hemianopsia and brain MRI confirmed symmetrical lesions within both LGNs. BCVA was gradually recovered, reaching 20/20 within 6 weeks.Results Lateral geniculate myelinolysis is an uncommon cause of acute bilateral vision loss which might cause retinal alterations by a retrograde way. Although MRI is the optimal imaging technique to confirm the diagnosis, OCT and visual field examination are able to detect subtle changes.Conclusion Binasal hemianopsia from intrageniculate myelinolysis has been described after rapid changes in serum sodium, following an emergency caesarean section or secondary to anaphylactic shock. To the best of our knowledge, this is the first case reported where it was induced by fluid and electrolyte imbalance in an acute pancreatitis.