No abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity presented with different symptoms such as visual disturbances, headaches, seizures, severe hypertension and altered mental status. It has been recognized in a different pathological conditions, although preeclampsia/eclampsia is the most common cause of PRES. The pathogenesis of PRES is still not fully understood, but it seems that failure of cerebrovascular autoregulation causing vasogenic edema, cerebral vasoconstriction, and disruption of the blood brain barrier plays an important role. Cortical blindness, hypertensive retinopathy, serous retinal detachment (SRD), central retinal artery and vein occlusions, retinal or vitreous hemorrhages, anterior ischemic optic neuropathy (AION) and Purtscher’s retinopathy are ophthalmic disorders that may occur in PRES associated with preeclampsia. Among these, cortical blindness is the best documented complication of preeclampsia. Magnet resonance imaging (MRI) is a gold standard to establish the diagnosis of PRES because clinical findings are not sufficiently specific. Typically, there are bilateral cortical occipital lesions with hyperdensity on T2-weighted MRI. Blindness due to occipital lesions is reversible and the vision loss is usually regained within 4 h to 8 days.

Central serous chorioretinopathy (CSCR) is a relatively common retinal disease involving the localized serous detachment of the neurosensory retina from the retinal pigment epithelium (RPE). Research suggests that individuals with a Type A personality, exhibiting traits such as competitiveness, urgency, aggression, and hostility, are significantly more prone to developing CSCR. Several studies have confirmed that a propensity to stress as well as different stressful events may predispose subjects to the development and recurrence of CSCR. Patients with CSCR are more depressive, report a higher level of anxiety and use more psychopharmacologic medications. Despite the research conducted on the topic, it remains unclear how a variety of psychological factors can contribute to dysfunction and pathological changes in the choroid and RPE. Some authors propose that increased levels of sympathetic neurotransmitters and glucocorticoids may alter the choroidal blood flow and increase the permeability of choriocapillaris in CSCR patients. It is generally accepted that hyperpermeable choroidal vessels are responsible for increased tissue hydrostatic pressure, which promotes RPE detachment, breaks the barrier function of the RPE and leads to subretinal fluid accumulation. Although the etiological factors and pathophysiological mechanisms have still not been fully clarified, CSCR is most likely a multifactorial disease involving disturbed interrelationships between biological and psychological factors. This comprehensive review aims to provide an up-to-date exploration of the psychological factors and pathophysiological mechanisms associated with CSCR.