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JAMA Ophthalmology Clinical Challenge
May 2017

Retinal Vascular Changes in a Young Woman

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. 2017;135(5):497-498. doi:10.1001/jamaophthalmol.2016.4816

A woman in her teens with no relevant medical history was brought to the hospital for personality changes, headache, and decreased vision bilaterally. Review of systems was remarkable for concomitant hearing loss and vertigo for 1 month. She was alert but confused and disoriented, and she manifested gait imbalance and ataxia. White blood cell count was elevated at 14 600/μL (to convert to ×109 per liter, multiply by 0.001). Results from computed tomography of the head were normal, but magnetic resonance imaging of the brain revealed multifocal punctate areas of restricted diffusion. A lumbar puncture showed lymphocytosis (80%), normal glucose levels, and protein levels greater than 125 mg/dL. Results from cerebrospinal fluid polymerase chain reaction were negative for herpes simplex virus, varicella zoster virus, and cytomegalovirus. Results from laboratory tests for hypercoagulable states, antinucleolar antibodies, antineutrophilic cytoplasmic antibodies, human immunodeficiency virus, Lyme disease, and tuberculosis were unrevealing.