Background: Posterior reversible encephalopathy syndrome (PRES), which was described in 1996 by Hinchey et al., is characterized by a transient cerebral edema, mainly in the white matter of the occipital lobe. Patients present with headache, altered consciousness, altered mental function, seizures, and visual disturbances. We encountered a patient with PRES who exhibited bilateral central scotoma. We investigated the relationship between bilateral central scotoma in PRES and the visual cortex findings on magnetic resonance imaging (MRI).
Case: A 58-year old man suspected of recurrent systemic lupus erythematosus (SLE) accompanied by hypertension and bilateral visual disturbances was referred to our hospital. His corrected visual acuity was counting fingers for both the eyes. Both the eyes exhibited central scotoma. Petechia and cottonwool exudate were observed for both the eyes during fundus examination. Head MRI showed hyperintense areas in the bilateral parietal and occipital cortex and subcortical white matter. The sagittal view indicated hyperintense areas in the posterior calcarine sulcus. These findings led to the diagnosis of PRES. Corticosteroid therapy and antihypertensive drugs were initiated, following which the patient's visual acuity and field improved, and MRI lesions disappeared.
Conclusion: PRES presents with a variety of eye symptoms due to cerebral edema, but bilateral central scotoma is caused due to central and posterior calcarine sulcus edema.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 517-522, 2018.