J Korean Ophthalmol Soc.  2016 Sep;57(9):1498-1505. 10.3341/jkos.2016.57.9.1498.

A Case of Posterior Reversible Encephalopathy Syndrome with Bilateral Visual Impairment

• Kang MS
• Bang SK
• Kim TG
• Jin KH

• KMID: 2351886
• DOI: http://doi.org/10.3341/jkos.2016.57.9.1498

Abstract

PURPOSE
To report a case of recovery of bilateral cortical blindness in a patient with posterior reversible encephalopathy syndrome.
CASE SUMMARY
A 46-year-old female visited the ophthalmology department due to abrupt visual acuity decrease. Ten days earlier, she had received conservative management due to anemia caused by menorrhagia and uterine prolapse. She underwent a gynecological operation to remove a uterine myoma two days previously, and was given a blood transfusion postoperatively because of excessive bleeding. After the transfusion, she complained of acute blurred vision. Her best corrected visual acuity (BCVA) was hand motion 10 cm in both eyes. There were no abnormal specific findings except retinal dot hemorrhage at the temporal side in the left eye on fundus examination. Her pupillary light reflex was normal and optical coherence tomography examination was unremarkable in both eyes. However, flash visual evoked potential findings showed reduced P100 amplitude in both eyes and she was diagnosed with posterior reversible encephalopathy syndrome based on brain magnetic resonance imaging. After close observation without any treatment, the symptoms gradually improved. Finally, her BCVA recovered to 1.0 and P1 and P100 amplitudes were restored to normal range in both eyes at 16 weeks from the first diagnosis.
CONCLUSIONS
A patient complained of bilateral visual loss without other neurological symptoms after chronic blood loss and blood transfusion. She recovered visual acuity completely with prompt diagnosis of posterior reversible encephalopathy syndrome and close observation only.

Keyword

Bilateral visual impairment; Blood transfusion; Cortical blindness; Posterior reversible encephalopathy syndrome

MeSH Terms

Anemia
Blindness, Cortical
Blood Transfusion
Brain
Diagnosis
Evoked Potentials, Visual
Female
Hand
Hemorrhage
Humans
Leiomyoma
Magnetic Resonance Imaging
Menorrhagia
Middle Aged
Ophthalmology
Posterior Leukoencephalopathy Syndrome*
Reference Values
Reflex
Retinaldehyde
Tomography, Optical Coherence
Uterine Prolapse
Vision Disorders*
Visual Acuity
Retinaldehyde

Figure

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  Figure 1. At the first visit, fundus color photographs and optical coherence tomography images in both eyes. Fundus color photographs showed normal fundus of right eye (A) and dot retinal hemorrhage (red arrows) on left eye (B). Optical coherence tomography image showed no macular abnormalities on right eye (C) and left eye (D).

• 

  Figure 2. Serial changes of flash visual evoked potential (VEP) and pattern VEP in both eyes. Flash VEP findings showed reduced P1 amplitude in both eyes at the first visit (A) and pattern VEP findings showed reduced P100 amplitude in both eyes at 5 weeks later (B). Flash VEP recovered normal P100 amplitude at 16 weeks later (C) and pattern VEP recovered normal P100 amplitude at 16 weeks later, too (D).

• 

  Figure 3. Brain magnetic resonance imaging (MRI) at the 4th day after first symptom showed features of posterior reversible encephalopathy syndrome. Bilateral parieto-occipital lesions with a white matter predominance seen on T2-weighted MRI (A, white arrows) and fluid attenuated inversion recovery image (B, white arrows). Apparent diffusion coefficient maps (C, white arrows), which show a vasogenic pattern of edema in white matter. The diffusion-weighted image sequence shows slight heterogenous hyperintensity (D, black arrows). T2-weighted MRI taken 18 weeks later reveals resolution of previous lesion (E).

• 

  Figure 4. Serial changes of fundus color photographs in both eyes. Fundus color photograph showed normal fundus on right eye (A) and dot retinal hemorrhage (red arrow) on left eye (B) at 10 days and normal fundus in both eyes at 5 weeks later (C, D) and at 16 weeks later (E, F).

Reference

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