Persistent Cortical Blindness Following Posterior Reversible Encephalopathy Syndrome (PRES) as a Complication of COVID-19 Pneumonia

Abstract

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic emerged in China in December 2019. Since then, there have been growing reports of coronavirus disease 2019 (COVID-19) cases with neurological involvement. We present a case of a 54-year-old woman who presented with confirmed SARS-CoV-2 pneumonia, complicated by a prolonged intensive care stay and posterior reversible encephalopathy syndrome (PRES). This resulted in persistent cortical blindness (Anton's syndrome). PRES has only rarely been reported in relation to SARS-CoV-2 infection and no patients have developed persistent cortical blindness. We summarise the clinical presentation of the patient and review the current literature.

Persistent visual dysfunction following posterior reversible encephalopathy syndrome due to COVID‐19: Case series and literature review

“…Database search recovered 37 unique articles describing PRES and COVID‐19, of which five were excluded after abstract review. The remaining 32 articles underwent full text review; 22 articles met all inclusion criteria and contained detailed clinical information on 32 individuals with PRES and COVID‐19 [6–27]. All cases reported MRI findings consistent with a diagnosis of PRES (Table 1).…”

Posterior Reversible Encephalopathy Syndrome: Tips for Diagnosis and Treatment

“…Both these independent risk factors were seen in our case as well: our patient was on hemodialysis with end-stage renal failure and was suffering from an acute hypertensive emergency (his initial BP was 212/139 mmHg). PRES has also been identified in several other conditions such as eclampsia, those on immunosuppressive therapy after transplantation, sepsis, autoimmune conditions such as systemic lupus erythematosus, porphyria, and it has even been recently reported in a case of coronavirus disease 2019 (COVID-19) [2].…”

Abrupt bilateral blindness as a rare post-acute demyelinating consequence of COVID-19

“…Olfactory involvement, headache, and impaired consciousness were more commonly described [ 1 ]. Although rare, visual loss was described as an uncommon complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [ [2] , [3] , [4] , [5] , [6] ]. The major causes of visual loss in the acute or post-acute phase of the SARS-CoV-2 infection are cerebrovascular attacks [ 2 ], encephalitis [ 3 ], post reversible encephalitis syndrome (PRES) [ 4 ], and herpes simplex viruses (HSV) reactivation-related retinal necrosis [ 5 ].…”

“…Although rare, visual loss was described as an uncommon complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [ [2] , [3] , [4] , [5] , [6] ]. The major causes of visual loss in the acute or post-acute phase of the SARS-CoV-2 infection are cerebrovascular attacks [ 2 ], encephalitis [ 3 ], post reversible encephalitis syndrome (PRES) [ 4 ], and herpes simplex viruses (HSV) reactivation-related retinal necrosis [ 5 ]. Likewise, demyelination was a recognized mechanism linked to SARS-CoV-2 blindness in patients with COVID-19-related autoimmune disorder of the central nervous system (CRAD-C) [ 6 , 7 ].…”