2026 American Academy of Neurology Abstract Website

Objective:

To describe a rare case of reversal of vision metamorphopsia (RVM) following cerebellar infarct and central retinal artery occlusion (CRAO), highlighting the interplay between retinal and central nervous system ischemia and the importance of multidisciplinary management.

Background:

RVM is an uncommon visual disturbance characterized by transient perception of an upside-down environment, most often associated with posterior circulation ischemia. The pathophysiology is not fully understood but is thought to involve disruption of visual or vestibular pathways. CRAO is a vision-threatening emergency, typically embolic in origin, and rarely co-occurs with central nervous system infarcts.

Design/Methods:

N/A

Results:

An 86-year-old male with nephrotic syndrome, diabetes, and hypertension presented with sudden, painless left eye vision loss. Examination revealed left nasal field loss with preserved temporal vision. Ophthalmology confirmed CRAO. Brain MRI identified acute left basal ganglia and right cerebellar lacunar infarcts. Six days into admission, the patient developed RVM, with transient episodes of upside-down vision and right eye diplopia, without other new deficits. Imaging showed no new infarcts. Visual disturbances resolved spontaneously. Workup revealed a mitral valve lesion suggestive of non-infective endocarditis, with negative blood cultures and elevated inflammatory markers. The patient was managed with dual antiplatelet therapy and transitioned to anticoagulation and antibiotics.

Conclusions:

This case illustrates the complex neurovascular interactions underlying RVM, particularly when both retinal and cerebellar ischemia are present. It highlights the need for comprehensive cardiovascular and neurological evaluation in patients with acute visual disturbances and supports the role of neuroplasticity in symptom resolution. Multidisciplinary collaboration is essential for optimal diagnosis and management.