title: Color vision abnormality as the sole manifestation of posterior reversible encephalopathy due to post-partum HELLP syndrome.
abstract: Posterior reversible encephalopathy syndrome (PRES) is associated with several symptoms; of those, visual acuity loss, light oversensitivity (photophobia), and light flashes (photopsia) are known as PRES-related eye symptoms. We report a post-partum woman with PRES associated with hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP), in whom color vision abnormality (achromatopsia) was the sole manifestation. Cesarean section was performed at 28 weeks due to headache, epigastralgia, and severe hypertension. HELLP became evident after delivery. On post-partum day 1, she complained of achromatopsia, stating: "all things look brownish-gray". Ophthalmologic examination was normal, but brain magnetic resonance imaging showed occipital lobe lesions, indicative of PRES, and, interestingly, also color vision center (area V4) lesions, suggesting that the achromatopsia had been caused by brain damage. It may be prudent to question HELLP patients concerning achromatopsia.
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: Department of Ophthalmology, Jichi Medical University, Tochigi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Makino
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Horie
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D003117:Color Vision Defects / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D017359:HELLP Syndrome / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009778:Occipital Lobe / Q000473:pathology; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications* / Q000473:pathology; D049590:Postpartum Period; D011247:Pregnancy
keywords: HELLP syndrome; achromatopsia; magnetic resonance imaging; posterior reversible encephalopathy syndrome; pre-eclampsia