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Published on: July 21, 2013
Acute cortical blindness due to posterior reversible encephalopathy
Jenny Nguyen-Lam1, Matthew C Kiernan
1Prince of Wales Clinical School, Prince of Wales Medical Research Institute, University of New South Wales; Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Summary
Posterior reversible encephalopathy syndrome (PRES) can cause temporary blindness and seizures in hypertensive patients. Prompt antihypertensive therapy can lead to complete vision recovery, supporting the vasogenic theory of PRES.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by altered mental status, seizures, and visual disturbances.
- Acute hypertension is a significant risk factor for developing PRES, impacting cerebral vascular autoregulation.
Observation:
- A 55-year-old male with acute hypertension presented with seizures and cortical blindness post-operatively.
- CT scans showed occipital lobe hypointensities, while MRI revealed symmetrical bilateral hyperintensities in the grey and white matter of the occipital lobes.
Findings:
- Thromboembolic screening and echocardiography were largely unremarkable, ruling out common causes of such neurological deficits.
- The patient was diagnosed with PRES, with complete resolution of cortical blindness following antihypertensive treatment.
Implications:
- This case reinforces the vasogenic theory of PRES, emphasizing the role of severe blood pressure fluctuations in compromising cerebral autoregulation.
- The findings highlight the importance of recognizing PRES in hypertensive patients and the efficacy of prompt blood pressure management for visual recovery.
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