Bilateral Occipital Lobe Hemorrhages Presenting as Denial of Blindness in Posterior Reversible Encephalopathy Syndrome– A Rare Combination of Anton Syndrome and Encephalopathy

Godasi, Raja; Rupareliya, Chintan; Bollu, Pradeep C.

doi:10.7759/cureus.1746

Cited by 5 publications

(4 citation statements)

References 12 publications

(31 reference statements)

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“…We identified 24 cases of visual deficits without awareness 2,21–41 (visual anosognosia, see Fig 1, Tables S1, S2), 69 cases of visual deficits with awareness, 11 95 cases of motor deficits without awareness (motor anosognosia), and 79 cases of motor deficits with awareness 1 from several sources. The network of voxels connected to each lesion location was computed and the resulting 267 lesion networks were entered into a single voxelwise ANOVA (see Fig 2).…”

Section: Resultsmentioning

confidence: 99%

Network Localization of Awareness in Visual and Motor Anosognosia

Kletenik,

Gaudet,

Prasad

et al. 2023

Annals of Neurology

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ObjectiveUnawareness of a deficit, anosognosia, can occur for visual or motor deficits and lends insight into awareness itself; however, lesions associated with anosognosia occur in many different brain locations.MethodsWe analyzed 267 lesion locations associated with either vision loss (with and without awareness) or weakness (with and without awareness). The network of brain regions connected to each lesion location was computed using resting‐state functional connectivity from 1,000 healthy subjects. Both domain specific and cross‐modal associations with awareness were identified.ResultsThe domain‐specific network for visual anosognosia demonstrated connectivity to visual association cortex and posterior cingulate while motor anosognosia was defined by insula, supplementary motor area, and anterior cingulate connectivity. A cross‐modal anosognosia network was defined by connectivity to the hippocampus and precuneus (false discovery rate p < 0.05).InterpretationOur results identify distinct network connections associated with visual and motor anosognosia and a shared, cross‐modal network for awareness of deficits centered on memory‐related brain structures. ANN NEUROL 2023

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Section: Resultsmentioning

confidence: 99%

Network Localization of Awareness in Visual and Motor Anosognosia

Kletenik,

Gaudet,

Prasad

et al. 2023

Annals of Neurology

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“…Our study revealed a strong correlation between vision loss, among all other presentations, with intracranial hemorrhage (OR 3.76, p = 0.003). The pathogenesis of parenchymal or sulcal subarachnoid hemorrhage in PRES could be due to either post-ischemic reperfusion damage or impaired autoregulation [ 18 , 19 ]. Speech difficulty was reported in 64 patients (10.1%).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of patients admitted to hospitals for posterior reversible encephalopathy syndrome: a retrospective cohort study

et al. 2021

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Background Posterior reversible encephalopathy syndrome (PRES) is usually a benign, yet underdiagnosed clinical condition associated with subacute to acute neurological manifestations primarily affecting white matter. PRES is reversible when recognized promptly and treated early by removal of the insulting factor; however, can lead to irreversible and life-threatening complications such as cerebral hemorrhage, cerebellar herniation, and refractory status epilepticus. Methods We utilized the National Inpatient Sample database provided by the Healthcare Cost and Utilization Project (HCUP-NIS) 2017 to investigate the demographic variables (age, sex, and race) for patients with PRES, concomitant comorbidities and conditions, inpatient complications, inpatient mortality, length of stay (LOS), and disposition. Results A total of 635 admissions for patients aged 18 years or older with PRES were identified. The mean age was 57.2 ± 0.6 years old with most encounters for female patients (71.7%, n = 455) and white as the most prevalent race. Half the patients in our study presented with seizures (50.1%, n = 318), sixty-three patients (9.9%) presented with vision loss, and sixty-four patients (10.1%) had speech difficulty. In addition, 45.5% of patients had hypertensive crisis (n = 289). 2.2% of hospitalizations had death as the outcome (n = 14). The mean LOS was 8.2 (±0.3) days, and the mean total charges were $92,503 (±$5758). Inpatient mortality differed between males and females (1.7% vs. 2.4%) and by race (3.6% in black vs. 1.8% in white) but was ultimately determined to be not statistically significant. Most patients who present with vision disturbance have a high risk of intracranial hemorrhage. Furthermore, end-stage renal disease, atrial fibrillation, and malignancy seemed to be linked with a very high risk of mortality. Conclusion PRES, formerly known as reversible posterior leukoencephalopathy, is a neurological disorder with variable presenting symptoms. Although it is generally a reversible condition, some patients suffer significant morbidity and even mortality. To the best of our knowledge, this is the largest retrospective cohort of PRES admissions that raises clinician awareness of clinical characteristics and outcomes of this syndrome.

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“…The most common cause of spontaneous intracerebral haemorrhage is hypertensive vasculopathy 6–8. But in cases of lobar haemorrhages, cerebral amyloid angiopathy (CAA) should also be considered as a potential cause,9 10 especially when dealing with recurrent lobar haemorrhages in a patient above the age of 55 11. CAA tends to favour areas of brain supplied by posterior circulation, meaning areas perfused by the vertebra-Basilar system.…”

Section: Discussionmentioning

confidence: 99%

Anton’s syndrome: a rare and unusual form of blindness

2019

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Anton syndrome is characterised by visual anosognosia. It results from damage to both occipital lobes, while the anterior visual pathways remain intact. We describe four cases of Anton’s syndrome. First case is that of a 73-year-old woman, who presented with two separate events of intraparenchymal brain haemorrhage, 4 years apart. Her first stroke affected the left and second affected the right occipital lobe. Bilateral occipital lobe damage resulted in cortical blindness. Second case is an 88-year-old man, who suffered from two ischaemic strokes, 2 days apart. Each stroke involved one posterior cerebral artery. This resulted in bilateral occipital and temporal lobe infarcts. Third case is a 64-year-old woman with chronic renal failure, who suffered bilateral occipital lobe infarction after haemodialysis, due to posterior reversible encephalopathy syndrome. Last case is that of an 80-year-old woman who suffered a basilar artery stroke, resulting in bilateral thalamic, temporal and occipital lobe infarction.

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Bilateral Occipital Lobe Hemorrhages Presenting as Denial of Blindness in Posterior Reversible Encephalopathy Syndrome– A Rare Combination of Anton Syndrome and Encephalopathy

Cited by 5 publications

References 12 publications

Network Localization of Awareness in Visual and Motor Anosognosia

Network Localization of Awareness in Visual and Motor Anosognosia

Clinical characteristics and outcomes of patients admitted to hospitals for posterior reversible encephalopathy syndrome: a retrospective cohort study

Anton’s syndrome: a rare and unusual form of blindness

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