title: [Acute posterior multifocal placoid pigment epitheliopathy. A rare cause of ischaemic stroke].
abstract: BACKGROUND
  Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory disease, generally of unknown aetiology, affecting the choriocapillaris, the pigment epithelium and the outer retina. It predominantly affects young patients and in some cases may involve the central nervous system in the form of strokes or meningoencephalitis. We report the clinical case of a young female with APMPPE that was complicated by stroke and intracranial hypertension.
  
  
  METHODS
  Our patient was a 16-year-old female who began with intense headaches suggesting intracranial hyper-tension, as well as with an acute deficit in the left hemisphere. A magnetic resonance scan of the head revealed embolic or vasculitic lesions in different territories. No evidence of meningoencephalitis was found in the cerebrospinal fluid analysis, but signs of associated intracranial hypertension were observed. The presence of very specific lesions in the posterior pole of the eye led to a diagnosis of APMPPE complicated by ischaemic stroke, probably caused by a vasculitic mechanism. An extensive aetiological study failed to identify a clear precipitating factor underlying the process. Treatment with corticoids was established, with good clinical and radiological progression.
  
  
  CONCLUSIONS
  APMPPE is an infrequent condition that generally has a good prognosis. In some cases, however, complications may arise owing to involvement of the central nervous system, and ischaemic stroke secondary to vasculitis is the most severe complication. In young patients with stroke who present visual symptoms and chorioretinital lesions, APMPPE must be considered in the aetiological diagnosis.
authors.affiliation: Servicio de Neurología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España. pablodelsaz1@gmail.com
authors.forename: Pablo
authors.initials: P
authors.lastname: del Saz-Saucedo
authors.forename: Laura Blanca
authors.initials: LB
authors.lastname: Alfaya-Muñoz
authors.forename: Marta
authors.initials: M
authors.lastname: Recio-Bermejo
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Lara-Medina
authors.forename: Amalia
authors.initials: A
authors.lastname: García-Chiclano
authors.forename: Teresa
authors.initials: T
authors.lastname: Ortega-León
authors.forename: Ignacio
authors.initials: I
authors.lastname: Rueda-Medina
authors.forename: María José
authors.initials: MJ
authors.lastname: Domínguez-Fernández
authors.forename: Carmen
authors.initials: C
authors.lastname: Madrid-Muñiz
authors.forename: María
authors.initials: M
authors.lastname: Franco-Huerta
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000209:etiology*; D015862:Choroid Diseases / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005451:Fluorescein Angiography; D006261:Headache / Q000209:etiology; D006423:Hemianopsia / Q000209:etiology; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008590:Meningoencephalitis / Q000175:diagnosis; D059906:Neuroimaging; D010211:Papilledema / Q000209:etiology; D010612:Pharyngitis / Q000150:complications; D012164:Retinal Diseases / Q000150:complications* / Q000175:diagnosis; D055213:Retinal Pigment Epithelium / Q000473:pathology; D013064:Speech Disorders / Q000209:etiology; D014657:Vasculitis / Q000150:complications*