Ophthalmic Disorders in Posterior Reversible Encephalopathy Syndrome Associated with Preeclampsia

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity presented with different symptoms such as visual disturbances, headaches, seizures, severe hypertension and altered mental status. It has been recognized in a different pathological conditions, although preeclampsia/eclampsia is the most common cause of PRES. The pathogenesis of PRES is still not fully understood, but it seems that failure of cerebrovascular autoregulation causing vasogenic edema, cerebral vasoconstriction, and disruption of the blood brain barrier plays an important role. Cortical blindness, hypertensive retinopathy, serous retinal detachment (SRD), central retinal artery and vein occlusions, retinal or vitreous hemorrhages, anterior ischemic optic neuropathy (AION) and Purtscher’s retinopathy are ophthalmic disorders that may occur in PRES associated with preeclampsia. Among these, cortical blindness is the best documented complication of preeclampsia. Magnet resonance imaging (MRI) is a gold standard to establish the diagnosis of PRES because clinical findings are not sufficiently specific. Typically, there are bilateral cortical occipital lesions with hyperdensity on T2-weighted MRI. Blindness due to occipital lesions is reversible and the vision loss is usually regained within 4 h to 8 days.

A Case of Onset and Treatment on Purtscher’s Retinopathy in a Single Eye

Background:Purtscher’s retinopathy is an occlusive microvasculopathy caused by traumatic injuries, especially like head and chest injuries. The exact mechanism of injury remains unclear, and Most case reports about Purtscher’s retinopathy focused on the symptoms of fundus, and did not provide detailed medical treatments. Case presentation: In this case, the patient suffered suddenly vision loss in the right eye one day after a traffic accident with moderate head and chest injuries. Ocular examinations revealed typical characteristics of cotton wool spots, and minimal intraretinal hemorrhages around the optic disc. 5 different drugs were used in this patient. 15 days after the treatment (corticosteroids and traditional Chinese medicine), the vision of the patient was improved and the symptoms (cotton wool spots, hemorrhages, retinal edema and visual field) were alleviated obviously. Conclusions: Corticosteroids and traditional Chinese medicines used in our case did improve the vision of the patient, and alleviated the symptoms of fundus.

A Rare Case of Purtscher’s Retinopathy Seen in RTA Patient

Purtscher's retinopathy was described by German Ophthalmologist Otmar Purtscher in 1910. It is an occlusive microvascular retinopathy caused by trauma such as head injury, thoracic compressive injury or long bone fractures.1Without history of trauma, it can also be due to systemic disease like acute pancreatitis, renal failure, lymphoproliferative disorder, valsalva maneuver, fat embolism syndrome or autoimmune diseases and they present with similar retinal findings and it is called Purtscher like retinopathy.

Purtscher’s retinopathy: a case report

Purtscher’s retinopathy is a rare haemorrhagic and vaso-occlusive vasculopathy following severe head trauma associated with sudden blindness. Here we report a case of 28 years old male pre­sented to out-patient department with history of sudden and painless loss of vision in his right eye for two days. He gave history of head injury following bike accident. At the time of presentation his best corrected visual acuity was 1/60 in the right eye and 6/6 in the left eye. On examina­tion, anterior segments of both eyes were normal. On fundus examination, right eye revealed retinal whitening in the peripapillary region (Purtscher’s flecken), an intraretinal hemorrhage and signs of macular edema whereas left eye was unremarkable. Findings were suggestive of right eye purtscher’s retinopathy. Optical coherence tomography and fundus fluorescence angiography was done to support the diagnosis. Purtscher’s retinopathy should not be neglected because it is associated with different systemic disease. Its pathophysiology remains unclear and there is no definite treatment but meticulous management is urgent to prevent from severe complications.