-Case Reports-

Permanent Bilateral Cortical Blindness Due to Reversible Posterior Leukoencephalopathy Syndrome

Mayumi Iwama^1,2, Hiroshi Takahashi^1,2, Ryo Takagi³ and Miki Hiraoka⁴

¹Department of Ophthalmology, Graduate School of Medicine, Nippon Medical School
²Department of Ophthalmology, Nippon Medical School
³Department of Radiology, Nippon Medical School
⁴Department of Ophthalmology, Sapporo Medical University, Hokkaido

Reversible posterior leukoencephalopathy syndrome (RPLS) is induced by acute cerebral edema. Its symptoms include seizures, headache, altered mental status, and visual disturbances. The clinical and radiological findings are usually transient. This report describes a case of RPLS resulting in bilateral total blindness. A 40-year-old man presented with lethargy and bilateral visual loss. He had a 20-year history of hypertension, but had never been treated. On presentation, the left eye was able to perceive light, but the right eye was not. Radiological examination showed diffuse edema in the brain, and ocular fundus examination revealed severe bilateral hypertensive retinopathy. Antihypertensive therapy improved the patient's general condition, including blood pressure. Radiological findings 5 months later showed resolution of most of the abnormal signal areas. However, total blindness had developed in both eyes by day 15, and two courses of pulsed corticosteroid therapy failed to restore the visual loss.

J Nippon Med Sch 2011; 78: 184-188

Keywords
posterior leukoencephalopathy syndrome, hypertension retinopathy, blindness

Correspondence to
Mayumi Iwama, Department of Ophthalmology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
s00-038@nms.ac.jp

Received, December 15, 2010
Accepted, January 14, 2011