The Mystery of Zero Ishihara Plates with 20/20 Vision

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Identifier The_Mystery_of_Zero_Ishihara_Plates_with_2020_Vision
Title The Mystery of Zero Ishihara Plates with 20/20 Vision
Creator Vivian Paraskevi Douglas; Konstantinos Douglas; Nurhan Torun
Affiliation (VPD) (KD) (NT) Beth Israel Deaconess Medical Center
Subject Simultanagnosia; Neurodegeneration; Posterior Cortical Atrophy
Description Herein we present a case of 71-year-old retired teacher who presented with difficulty reading over the past year. On examination, the patient had difficulty identifying even the control plate on Ishihara testing in both eyes (OU), despite intact color recognition. Humphrey visual field testing revealed reproducible right sided visual field deficits OU at presentation. MRI of the brain had been done before we saw her and was initially read as unremarkable. However, upon review high signal intensity involving the subcortical white matter in the occipital lobe on the left, as well as encephalomalacia with increased CSF spaces were noted. The differential diagnosis included posterior cortical atrophy, a neurodegenerative condition. Her visual difficulty preceded the diagnosis of depression; the latter was actually believed to be due to having seen several eye doctors and not being given an explanation for the worsening vision. It is important to remember that inability to identify Ishihara color plates is sometimes the earliest sign of simultanagnosia. This case emphasizes the importance of performing a thorough history and examination, including interpretation of all exam findings, in order to timely diagnose and manage the underlying disorder.
Date 2024-01
References 1. Crutch SJ, Lehmann M, Schott JM, Rabinovici GD, Rossor MN, Fox NC. Posterior cortical atrophy. Lancet Neurol. 2012;11(2):170-178. doi:10.1016/S1474-4422(11)70289-7. 2. Best J, Chapleau M, Rabinovici GD. Posterior cortical atrophy: clinical, neuroimaging, and neuropathological features. Expert Rev Neurother. 2023;23(3):227-236. doi:10.1080/14737175.2023.2190885. 3. Maia da Silva MN, Millington RS, Bridge H, James-Galton M, Plant GT. Visual Dysfunction in Posterior Cortical Atrophy. Front Neurol. 2017;8:389. Published 2017 Aug 16. doi:10.3389/fneur.2017.00389.
Language eng
Format application/pdf
Format Creation Microsoft PowerPoint
Type Text
Collection Neuro-Ophthalmology Virtual Education Library: NOVEL https://NOVEL.utah.edu
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2024. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s65s514q
Setname ehsl_novel_novel
ID 2405560
Reference URL https://collections.lib.utah.edu/ark:/87278/s65s514q
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