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Images in Neurology |

What Lies Beyond Plain Sight

Clare Fraser, MBBS(Hons), MMed, FRANZCO; Hoskote Chandrashekar, MB, BS, DMRD; Gordon Plant, MD, FRCP, FRCOphth; Indran Davagnanam, MB, BCh, BAO, BMedSci, FRCR
Arch Neurol. 2012;69(4):538-540. doi:10.1001/archneurol.2011.1850.
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A 39-year-old man presented with 8 weeks of unilateral superior hemifield visual loss. He reported a generalized headache and a nonproductive cough for 3 months.

Visual acuity was 20/1200 OS and normal in the right eye. Slitlamp evaluation revealed an ischemic left branch retinal vein occlusion with macular edema, no evidence of uveitis, and no changes in the right eye. At 2 weeks' follow-up, bilateral disc edema was noted but with no focal neurological deficit. Enlarged cervical lymph nodes were found on systemic examination. A fluorescein angiogram did not demonstrate evidence of vasculitis or retinitis (Figure 1).

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Figure 1. Fundus photographs (right eye [A] and left eye [B]) and fluorescein angiograms (right eye [C] and left eye [D]) demonstrating bilateral disc edema, left inferotemporal branch retinal vein occlusion, and no evidence of vasculitis.

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Figure 2. Axial postcontrast computed tomography examination (A) demonstrating symmetrical confluent gyriform enhancing lesions in the parieto-occipital regions with associated underlying vasogenic edema. Axial T2-weighted magnetic resonance imaging (B) showing the same distribution of lesions with multiple small foci of hypointensity (arrows) within the gyral swelling and hyperintensity as well as underlying white matter edema. Axial (C) and coronal (D) post–gadolinium contrast magnetic resonance imaging demonstrating enhancement of these lesions.

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