| Cortical blindness: clinical and radiologic findings in reversible posterior leukoencephalopathy syndrome: case report and review of the literature. | |
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MedLine Citation:
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PMID: 15691546 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To alert ophthalmologists to the recognition of cortical visual loss as the presenting feature in patients with reversible posterior leukoencephalopathy syndrome (RPLES). Unique radiologic findings are paramount to the diagnosis. DESIGN: Interventional case report. METHODS: A patient was seen with perioperative bilateral cerebral visual loss that was misinterpreted initially as an irreversible ischemic event. Further detailed analysis of the radiologic findings and clinical history led to the correct diagnosis. MAIN OUTCOME MEASURES: Visual acuity and magnetic resonance imaging (MRI) of the brain. RESULTS: Recognition of the correct diagnosis of RPLES led to the institution of antihypertensive therapy and recovery of normal vision. CONCLUSIONS: The diagnosis of RPLES should be considered in all patients with acute cerebral visual loss, especially in the setting of recent surgery, blood transfusion, chemotherapy, immunosuppressant use, hypertension, eclampsia, or seizures. Prompt diagnosis requires close collaboration with a radiologist and an emergent MRI study, which ideally should include diffusion-weighted imaging with calculation of an apparent diffusion coefficient map. Differentiation from acute cerebral ischemia is important in order to avoid permanent visual loss by prompt and vigorous treatment of exacerbating factors such as intermittent hypertension. Prompt diagnosis will also help to avoid potentially dangerous invasive procedures such as thrombolytic therapy. |
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Authors:
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Alon Kahana; Howard A Rowley; Joel M Weinstein |
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Publication Detail:
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Type: Case Reports; Journal Article; Review |
Journal Detail:
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Title: Ophthalmology Volume: 112 ISSN: 1549-4713 ISO Abbreviation: Ophthalmology Publication Date: 2005 Feb |
Date Detail:
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Created Date: 2005-02-04 Completed Date: 2005-02-16 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 7802443 Medline TA: Ophthalmology Country: United States |
Other Details:
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Languages: eng Pagination: e7-e11 Citation Subset: IM |
Affiliation:
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Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine, Madison, Wisconsin 53705, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anticoagulants / therapeutic use Antihypertensive Agents / therapeutic use Blindness, Cortical / diagnosis*, drug therapy, physiopathology Blood Pressure Brain / pathology*, radiography Drug Therapy, Combination Female Fibrinolytic Agents / therapeutic use Humans Hypertensive Encephalopathy / diagnosis*, drug therapy, physiopathology Magnetic Resonance Imaging Prothrombin Time Syndrome Tomography, X-Ray Computed Visual Acuity |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Antihypertensive Agents; 0/Fibrinolytic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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