title: Vision Loss Caused by Retinal and Lateral Geniculate Nucleus Infarction in H1N1 Influenza.
abstract: A 13-year-old girl developed encephalopathy and severe bilateral vision loss to the level of light perception within 24 hours of having fever and myalgias heralding H1N1 influenza A. Ophthalmoscopy demonstrated findings of confluent ischemic retinopathy. Brain MRI disclosed lateral geniculate body signal abnormalities indicative of hemorrhagic infarction. Despite aggressive treatment with intravenous corticosteroids, intravenous immunoglobulin, and plasmapheresis, vision did not substantially improve. This case demonstrates that H1N1 can cause simultaneous retinal and lateral geniculate body infarctions, a combination of findings not previously described in any condition. We postulate an immunologic response to the virus marked by occlusive damage to arteriolar endothelium.
authors.affiliation: Department of Ophthalmology and Visual Sciences (DAB, AWS, LLCDB, JDT, MWJ), University of Michigan Kellogg Eye Center, Ann Arbor, Michigan; Division of (Neuroradiology), Department of Radiology (AS), University of Michigan, Ann Arbor, Michigan; and Department of Neurology (JDT), University of Michigan, Ann Arbor, Michigan.
authors.forename: Dane A
authors.initials: DA
authors.lastname: Breker
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Stacey
authors.forename: Ashok
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Lulu L C D
authors.initials: LL
authors.lastname: Bursztyn
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Trobe
authors.forename: Mark W
authors.initials: MW
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D001766:Blindness / Q000209:etiology*; D020520:Brain Infarction / Q000150:complications / Q000209:etiology / Q000821:virology; D005260:Female; D005829:Geniculate Bodies / Q000473:pathology*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D012160:Retina / Q000473:pathology*