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Transient Visual Field Defects in a case with Posterior Reversible Encephalopathy Syndrome Inako Ichikawa 1 , Takahisa Hirokawa 2 , Masahiro Tonari 2 , Junko Matsuo 2 , Hidehiro Oku 2 , Tsunehiko Ikeda 2 1Department of Ophthalmology, Saiseikai Suita Hospital 2Department of Ophthalmology, Osaka Medical College pp.359-364
Published Date 2021/3/15
DOI https://doi.org/10.11477/mf.1410213938
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Abstract Purpose:We report a patient with posterior reversible encephalopathy syndrome(PRES)who showed homonymous hemianopsia that was recovered by controlling blood glucose levels.

Case:A 36-year-old man was referred to our hospital due to a 2-week history of scintillating scotoma that was followed by sudden visual field defects. He also complained of headache and nausea.

Result:A blood test revealed untreated diabetes mellitus. Diffusion-weighted images(DWI)of MRI showed a high-intensity lesion in the right occipital lobe. T2-weighted images and fluid attenuated inversion recovery(FLAIR)images showed high-intensity lesions. A visual field test revealed left hemianopsia that was consistent with the right occipital lesions on MRI. He was diagnosed with PRES. After hospitalization in the department of neurosurgery, he was treated with anticoagulant antiepileptic medications, and with control of hyperglycemia. His visual field defects were improved and the abnormalities on MRI disappeared.

Conclusion:Increased vascular permeability and the breakdown of the blood-brain barrier are involved in the mechanism of onset of PRES, and usage of carcinostatic agents and uncontrolled hypertension are reported to cause PRES. Because reduction of blood glucose levels improved visual field defects and recovered abnormalities on MRI in this case, hyperglycemia may also cause PRES. This syndrome is reversible by proper medication, but early diagnosis is necessary based on the visual symptoms and MRI findings.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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