Sudden Reversible Painless Binocular Vision Loss - A New Cause: Case Report and Review of Literature (P06.256)

Abstract

Objective: To describe a case of isolated cortical blindness due to Hemorrhagic Posterior Reversible Encephalopathy Syndrome (HPRES) and review of literature. Background PRES is characterized by a variety of symptoms including headache, altered mental status, vision loss and seizures. Vasogenic edema is the characteristic radiological finding, hemorrahge is rare.Isolated cortical blindness due to HPRES has not been previously reported. Design/Methods: Case report and review of literature. Results: A 55- year- old white male was brought to the emergency department after he woke up with complete blindnessand mild headache His vitals inlcuded BP of 220/110 mm Hg, HR 80 and RR 12 and afebrile.His examination revealed complete blindness with no light perception but normal light reaction. The fundoscopy was normal. Rest of the neurological examiantion incliding higher mental function, cranial nerves, speech, strength and gait were normal. The Noncontrast CT head revealed intraparenchymal hemorrhage over bilateral occipital lobe with massive edema. MRI brain revealed occipial hematoma with vasogenic edema, no diffusion restriction. MR angiogram and venogram of brain were normal.His laboratory works included normal drug screen, vasculitic panel, PT/aPTT/INR. His vision started improving in 48 hours with significant recovery in 3 weeks ( 20/60) with resolution of hematoma on MRI. Conclusions: Isolated cortical blindness is a rare clinical presentation of Hemorrhagic PRES.It is important to recognize this condition given good prognosis. The most common postulates is endothelial cell dysfunction leading to blood-brain barrier leakage, with resultant cortical and subcortical vasogenic edema. Potential etiologic factors include eclampsia, or other causes, such as conditioning regimens before transplantation, effects of graft-versus-host disease, or the results of the immunosuppressive drugs cyclosporine and tacrolimus. Our patient did not had any of these factors. Studies have demonstrated that the incidence of parenchymal or sulcal Subarachnoid hemorrhage in PRES is around 5-17%. Exact pathophysiology is unknown. Disclosure: Dr. Bollu has nothing to disclose. Dr. Lim has nothing to disclose. Dr. Uppal has nothing to disclose. Dr. Singh has nothing to disclose.