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Acute posterior multifocal placoid pigment epitheliopathy and thalamic infarction
Jacob J Yunker1, Edgar L Ready, Charles L Tucker
1From the *Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama; and the †Helen Keller Foundation for Research and Education, Birmingham, Alabama.
Objectives:
To report a patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) who developed a thalamic infarction and to discuss this unusual presentation.
Design:
Interventional case report and literature review.
Methods:
A 23-year-old man with APMPPE presented with acute confusion and memory loss. He underwent complete ophthalmologic and neurologic examination, with neuroimaging including magnetic resonance angiography (MRA).
Main Outcome Measures:
Clinical course and angiographic findings.
Results:
Magnetic resonance imaging (MRI) showed a left posteromedial thalamic infarction, with a corresponding filling defect of the left posterior communicating artery demonstrated by MRA. The patient underwent further treatment with intravenous corticosteroids followed by continued oral therapy with taper over several weeks.
Conclusion:
Although the association of APMPPE and cerebral vasculitis has been described, this patient is unique due to the subtle clinical presentation and anatomic location. This case emphasizes the importance of appropriate counseling of patients with APMPPE, as well as prompt recognition of clinical symptoms to enable timely intervention and treatment.
Insights
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) can lead to thalamic infarction, as seen in a unique case with subtle symptoms. Prompt recognition and treatment are crucial for managing this rare neurological complication.
Area of Science:
- Ophthalmology
- Neurology
- Neuroscience
Background:
- Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an inflammatory eye condition.
- Cerebral vasculitis is a known, though uncommon, association with APMPPE.
Purpose of the Study:
- To report a rare case of APMPPE associated with thalamic infarction.
- To discuss the unusual clinical presentation and implications for patient management.
Main Methods:
- Case report of a 23-year-old male with APMPPE.
- Comprehensive ophthalmologic and neurologic examinations.
- Neuroimaging including MRI and MRA.
Main Results:
- A left posteromedial thalamic infarction was identified via MRI.
- MRA revealed a filling defect in the left posterior communicating artery.
- The patient was treated with intravenous and oral corticosteroids.
Conclusions:
- This case highlights a unique presentation of APMPPE with thalamic infarction.
- Emphasizes the need for vigilance regarding subtle neurological symptoms in APMPPE patients.
- Underscores the importance of timely diagnosis and intervention for potential cerebrovascular complications.
