2023 American Academy of Neurology Abstract Website

Objective:

To present a unique case of acute onset bilateral painless vision loss due to bilateral hemorrhagic infarction of the lateral geniculate bodies (LGB) and to conduct a systematic literature review to better understand the underlying pathophysiology.

Background:

Bilateral lateral geniculate body (LGB) infarct is an exceedingly rare cause of acute bilateral painless vision loss. A descriptive case report is presented on a 17-year old female diagnosed with acute pancreatitis who developed acute onset bilateral painless vision loss.

Design/Methods:

The systematic literature review was conducted on September 24th, 2022 in PubMed/PubMed Central/MEDLINE, ScienceDirect, and Scopus electronic databases. The following search string: ‘(lateral geniculate bod* OR lateral geniculate nucle*) AND (bilateral hemorrhagic infarct* OR bilateral ischemic infarct*). The review was prospectively registered on PROSPERO (Registration ID:CRD42022362491).

Results:

The reported 17-year old female was found to have purtscher-like retinopathy on fundoscopic evaluation as well as MRI findings consistent with bilateral hemorrhagic infarction of the LGB. A systematic literature review yielded 18 records for analysis. 15/18 (83.3%) of reported cases occurred in females. Bilateral vision loss was seen in all cases. Gastrointestinal pathology (i.e. pancreatitis, gastroenteritis, etc.) was seen in 7/18 (38.8%) of cases. Other reported causes include H1N1 influenza, extrapontine myelinolysis, preeclampsia, hysterectomy, methanol toxicity, traumatic brain injury, syphilitic arteritis, Behçet’s disease, and anaphylactic shock. All cases had MRI findings consistent with lesions to the bilateral LGB. 7/18 (38.8%) cases had neuroimaging or pathological evidence of hemorrhagic infarction of the LGB.

Conclusions:

Bilateral LGB infarction is a rare cause of vision loss. A systematic literature review and analysis of 18 cases revealed that it can concur due to a multitude of etiologies. It is often associated with an underlying inflammatory, coagulopathic, hypotensive, or osmotic pathology. Most reported cases are in females and occur due to a gastrointestinal etiology (i.e. acute pancreatitis, gastroenteritis, post-ERCP).