Occult retinitis pigmentosa simulating central nervous system disease

The case histories of 3 elderly patients with senile pigmentary dystrophy of the retina are presented. Recognition of this occult form of retinitis pigmentosa was obscured by the late onset of symptoms, lack of subjective night blindness, subtle fundus abnormalities, and absence of family history of eye disease. Unexplained visual field loss prompted invasive neurologic studies for suspected brain tumor in 2 patients and long-term anticoagulation administration in the third, who was believed to have primary cerebrovascular disease. Retinitis pigmentosa should be considered when evaluating older patients with field defects. Fluorescein angiography and electrophysiologic and psychophysical techniques are helpful in the differential diagnosis.