title: Delayed recurrent stroke in a young patient with acute posterior multifocal placoid pigment epitheliopathy.
abstract: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a chorioretinal disease that causes acute binocular visual disturbance with characteristic funduscopic lesions at the level of the retinal pigment epithelium. APMPPE has been associated with multiple neurologic complications, including cerebrovascular diseases. We report a 15-year-old patient who had bilateral APMPPE, which was successfully treated with corticosteroids. One year later he presented with transient dysarthria and right hemiparesis. Brain magnetic resonance imaging (MRI) showed bilateral ischemic lesions in both lenticular nuclei and corona radiata. Brain MRI performed 3 months later revealed a new asymptomatic ischemic lesion. Cerebral angiography showed diffuse multifocal segmental vessel narrowing. The cerebrospinal fluid showed mononuclear pleocytosis in keeping with vasculitis. We started corticosteroid treatment, which lasted 10 months. Currently, after 2 years of clinical and neuroradiologic follow-up, the patient is asymptomatic and shows no worsening of the cerebrovascular lesions.
authors.affiliation: Department of Neurological Science, Faculty of Medicine, Universidad de Chile, Santiago, Chile. Electronic address: jm_matamala@med.uchile.cl.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Matamala
authors.forename: Walter
authors.initials: W
authors.lastname: Feuerhake
authors.forename: Renato
authors.initials: R
authors.lastname: Verdugo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002533:Cerebral Angiography; D015862:Choroid Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004401:Dysarthria / Q000209:etiology; D005451:Fluorescein Angiography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010291:Paresis / Q000209:etiology; D011237:Predictive Value of Tests; D012008:Recurrence; D012164:Retinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D055213:Retinal Pigment Epithelium / Q000187:drug effects / Q000473:pathology*; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones