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[Irreversible bilateral amaurosis in a 36-year-old immigrant]
P Mäder1, M Baumgartner, M Arnold
1Klinik für Allgemeine Innere Medizin, Inselspital Bern.
Praxis
|April 6, 2004
Summary
A young man experienced bilateral blindness and right arm weakness, initially misdiagnosed as psychogenic. Subsequent stroke in the posterior cerebral arteries caused neurological deficits, highlighting the need for thorough investigation of rare stroke causes.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Medicine
Background:
- A 36-year-old male presented with initial symptoms of right arm weakness and bilateral blindness following mild head trauma.
- Initial clinical evaluation and computed tomography (CT) scan of the brain showed no pathological findings, leading to a diagnosis of psychogenic disorder.
Observation:
- Nine days post-initial assessment, the patient developed an unstable gait, childlike demeanor, amnesia, and enuresis.
- A follow-up CT scan revealed a subacute bilateral occipital stroke affecting the posterior cerebral artery territories.
Findings:
- The patient presented with a rare combination of symptoms, including bilateral blindness and subsequent neurological deficits indicative of stroke.
- The stroke occurred in the occipital lobes, supplied by the posterior cerebral arteries, despite initial negative findings.
Implications:
- This case underscores the importance of comprehensive medical history and clinical examination, even with initial negative results, in young patients presenting with unusual neurological symptoms.
- Rare presentations of stroke, such as cortical blindness preceding overt stroke, necessitate further investigation to avoid misdiagnosis and ensure timely intervention.