RESIDENT
& FELLOW
SECTION
Section Editor
Mitchell S.V. Elkind,
MD, MS

Teaching NeuroImages:
Stroke and bilateral visual loss in a
young adult
More than coincidence

B. Volbers, MD*
K. Kaldefoss, MD*
A. Bergua, MD
S. Kloska, MD
S. Schwab, MD
M. Köhrmann, MD

Figure 1

MRI and conventional angiography at admission and MRI after 1 week of treatment with
corticosteroids

Correspondence & reprint
requests to Dr. Volbers:
bastian.volbers@uk-erlangen.de

At admission, diffusion-weighted imaging (A) showed a small ischemic lesion (arrow) in the territory of the left middle
cerebral artery, which was stenotic on magnetic resonance angiography (B, arrows) and conventional angiography (C, arrows). After 1 week of corticosteroid treatment, vessel caliber returned to normal (D, arrow).

A 22-year-old man presented with right-sided hemihypesthesia and transient aphasia after a month of
progressive bilateral visual loss. MRI on admission
revealed ischemic stroke in the left middle cerebral
artery (MCA) territory and MCA stenosis, which was
confirmed by ultrasound and conventional angiography (figure 1). Diagnostic workup was unremarkable
except for CSF pleocytosis (16 leukocytes). Ophthalmologic examination, including fluorescein angiography, diagnosed acute posterior multifocal placoid
pigment epitheliopathy (figure 2), a rare disorder of
the choroid and retina that can also be associated
with CSF pleocytosis, cerebral artery stenoses, and
stroke.1,2 The patient was treated with corticosteroids
and azathioprine and recovered without sequelae.

AUTHOR CONTRIBUTIONS
Bastian Volbers: designed the research, collected the data, and drafted the
manuscript. Kristine Kaldefoss: collected the data and critically revised the
manuscript. Antonio Bergua: collected the data and critically revised
the manuscript. Stephan Kloska: collected the imaging data and critically
revised the manuscript. Stefan Schwab: collected the data and critically
revised the manuscript. Martin Köhrmann: designed the research, collected the data, and drafted the manuscript.

REFERENCES
1.
Luneau K, Newman NJ, Srivastava S, Biousse V. A case of
acute posterior multifocal placoid pigment epitheliopathy
with recurrent stroke. J Neuroophthalmol 2009;29:
111–118.
2.
Comu S, Verstraeten T, Rinkoff JS, Busis NA. Neurological manifestations of acute posterior multifocal placoid
pigment epitheliopathy. Stroke 1996;27:996 –1001.

*These authors contributed equally to this work.
From the Departments of Neurology (B.V., S.S., M.K.), Ophthalmology (K.K., A.B.), and Neuroradiology (S.K.), University Hospital Erlangen,
Erlangen, Germany.
Disclosure: The authors report no disclosures.
e80

Copyright © 2012 by AAN Enterprises, Inc.

Figure 2

Ophthalmologic examination including funduscopy and fluorescein angiography

Funduscopy showed typical white dots (left arrows) with retinal pigment epithelium scar formation (A). Fluorescein angiography demonstrated hypofluorescent lesions characteristic of acute posterior multifocal placoid pigment epitheliopathy in
the early phase (B) with late hyperfluorescence of the chorioretinal scar near the macula (C).

Neurology 78

March 20, 2012

e81

Teaching NeuroImages: Stroke and bilateral visual loss in a young adult: More than
coincidence
B. Volbers, K. Kaldefoss, A. Bergua, et al.
Neurology 2012;78;e80-e81
DOI 10.1212/WNL.0b013e31824c46e3
This information is current as of March 19, 2012
Updated Information &
Services

including high resolution figures, can be found at:
http://www.neurology.org/content/78/12/e80.full.html

References

This article cites 2 articles, 1 of which you can access for free at:
http://www.neurology.org/content/78/12/e80.full.html##ref-list-1

Subspecialty Collections

This article, along with others on similar topics, appears in the
following collection(s):
Retina
http://www.neurology.org//cgi/collection/retina
Stroke in young adults
http://www.neurology.org//cgi/collection/stroke_in_young_adults
Visual loss
http://www.neurology.org//cgi/collection/visual_loss

Permissions & Licensing

Information about reproducing this article in parts (figures,tables) or in
its entirety can be found online at:
http://www.neurology.org/misc/about.xhtml#permissions

Reprints

Information about ordering reprints can be found online:
http://www.neurology.org/misc/addir.xhtml#reprintsus

Neurology ® is the official journal of the American Academy of Neurology. Published continuously since
1951, it is now a weekly with 48 issues per year. Copyright Copyright © 2012 by AAN Enterprises, Inc.. All
rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.