Permanent bilateral cortical blindness due to reversible posterior leukoencephalopathy syndrome

Abstract

Reversible posterior leukoencephalopathy syndrome (RPLS) is induced by acute cerebraledema. Its symptoms include seizures, headache, altered mental status, and visualdisturbances. The clinical and radiological findings are usually transient. This report describesa case of RPLS resulting in bilateral total blindness. A 40-year-old man presented with lethargyand 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. Radiologicalexamination showed diffuse edema in the brain, and ocular fundus examination revealedsevere bilateral hypertensive retinopathy. Antihypertensive therapy improved the patient'sgeneral condition, including blood pressure. Radiological findings 5 months later showedresolution of most of the abnormal signal areas. However, total blindness had developed inboth eyes by day 15, and two courses of pulsed corticosteroid therapy failed to restore thevisual loss.