Isolated cortical blindness without simultaneous neurological involvement in progressive multifocal leukoencephalopathy in a patient with human immune deficiency virus infection

Abstract

BackgroundThis is a case report of cortical blindness in a HIV-positive patient with progressive multifocal leukoencephalopathy (PML) without any other associated neurological dysfunction.FindingsYoung HIV-positive patient presented to us with sudden profound visual loss. On examination and further investigation, we have diagnosed cortical blindness without any other focal neurological deficit due to PML.ConclusionOur case highlights the fact that PML needs to be suspected in patients with HIV, presenting with cortical blindness even without any other focal neurological defect.

A Review Study on Ocular Posterior Segments & Neuro-Ophthalmic Manifestations Associated with Human Immunodeficiency Virus (HIV) Infection and its Management Options

“…[50] There have been a few isolated reports of zidovudine-induced anaemia leading to papilledema from idiopathic intracranial hypertension (IIH). [51][52] In immunocompetent people, cat scratch disease (CSD), which is brought on by Bartonella hensela, manifests as a neural retinitislike symptom. Patients who are HIV positive display different symptoms, such as vascular abnormalities and aberrant vascular network formations, among others.…”

Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy – An update

“…Cortical blindness without their classical neurological manifestations as the presenting feature has been reported. [ 77 ]…”

Subacute visual loss as the sole presenting feature in progressive multifocal leukoencephalopathy

“…PML is a rare demyelinating disease of the central nervous system (CNS) caused by JC virus, a human DNA polyomavirus. 1 About 90% of adults are seropositive for this ubiquitous virus. 2 However, PML affects almost exclusively patients with impaired cell-mediated immunity.…”

“…1 Some of the common clinical features include motor weakness, cognitive deficits, dysphasia and incoordination. 1,5 Vision loss is seen in up to 50% of PML cases and ranges from very mild to cortical blindness, depending on the extent of occipital lobe involvement. 2 Visual symptoms without associated neurologic signs are infrequent.…”

“…2 Visual symptoms without associated neurologic signs are infrequent. 1 This patient initially presented with a 3-month history of moderate bilateral vision loss as the sole clinical manifestation of bilateral occipital lobe demyelination. It took several weeks for other neurological symptoms to appear, even though the initial MRI showed scattered white matter lesions outside the occipital lobes.…”