Bilateral isolated lateral geniculate body lesions in a patient with pancreatitis and microangiopathy

An 18-year-old woman developed pancreatitis and a thrombotic microangiopathy but no electrolyte abnormalities. She required intubation hours after admission and was not able to communicate for 8 days. Upon recovering consciousness, she reported severely impaired vision in both eyes, but ophthalmologic evaluation and neuroimaging were not obtained until several days later. Ophthalmologic examination documented retinal infarcts and profound binocular vision loss with hourglass bilateral homonymous hemianopic visual field loss. MRI showed signal abnormalities restricted to the area of the lateral geniculate bodies (LGBs) with characteristics most suggestive of hemorrhagic infarction. Very few cases of isolated bilateral LBG lesions have been reported. Damage has been attributed to myelinolysis from osmotic demyelination or to infarction from microvascular occlusion. This case conforms more to microvascular infarction. The vulnerability of the LGB to selective microvascular infarction may be based on a combination of its unique architecture and high metabolic demand.