Title (croatian) Posteriorna kortikalna atrofija – izazov za oftalmologe Title (english) Posterior cortical atrophy – a challenge for ophthalmologists Author Branimir Cerovski Author Tomislav Vidović Author Zlatko Juratovac Author Smiljka Popović Suić Author's institution University of Zagreb Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract (croatian) Posteriorna kortikalna atrofija (PCA) je neurodegenerativno kliničko-radiološko stanje s atrofijom posteriornih dijelova moždanog korteksa uključujući vidni korteks i dijelove parijetalnog i temporalnog korteksa.
Nespecifični vidni poremećaji često se pogrešno interpretiraju kao oftalmološki, što vodi prema zakašnjeloj pravoj dijagnozi. Razlikovanje PCA od drugih bolesti može biti zahtjevno i može oduzeti mnogo vremena. Prikazuje se bolesnica s PCA u dobi od 57 godina koja godinama pokazuje vidne perceptualne poremećaje koji se inicijalno
dijagnosticiraju kao oftalmološke bolesti te potom kao neobjašnjeno oštećenje vida. Dvadeset pet godina ranije obostrano je učinjena radijarna keratotomija, a šest godina prije prijema u oba se oka implantira fakična intraokularna Verisyse leća. Unazad četiri godine liječi glaukomsku bolest. Tijekom neurooftalmološke opservacije nije potvrđena sumnja na optičku neuropatiju niti na makulopatiju. Pažljivom anamnezom saznaje se da obitelj već godinama ranije zapaža tegobe bolesnice kod prepoznavanja lica, pri čitanju i pisanju. Navode se tegobe procjene dubine i prostorne orijentacije, problemi sa stepenicama, osobito pri silasku. Nađena je velika diskrepancija između iskazanih funkcionalnih vizualnih oštećenja (vidna oštrina, vidno polje, Ishihara kolorni test) s jedne strane i s druge strane urednoga oftalmoskopskog nalaza na mrežnicama i urednog morfološkog nalaza OCT dijagnostike. Učinjena MR pretraga također otvara sumnju na kortikalnu problematiku te je bolesnica usmjerena na daljnju neurološku i neuro-radiološku opservaciju uz PET-FDG, što je dovelo do dijagnoze PCA. PCA je važan
dijagnostički entitet jer se ti bolesnici obično najprije javljaju oftalmolozima i nerijetko se svrstavaju u skupinu onih s neobjašnjenim oštećenjem vida. Kod diskrepancije vizualnih oštećenja registriranih funkcionalnom dijagnostikom u odnosu na srazmjerno uredan oftalmoskopski nalaz i nalaz OCT dijagnostike, važno je ponovno pažljivo provjeriti anamnezu i heteroanamnezu i pomisliti na mogućnost kortikalnog uzroka iskazanih oštećenja s ciljem ranog otkrivanja uzroka neobjašnjenog oštećenja vida. Tu je važna dobra suradnja s kognitivnim neurolozima specijaliziranim za neurodegenerativne bolesti. Cilj je rada podignuti svijest liječnika o postojanju ovog entiteta kao mogućeg uzroka neobjašnjenog gubitka vida i olakšati rano prepoznavanje uz primjenu odgovarajućih dijagnostičkih metoda.
Abstract (english) Posterior cortical atrophy (PCA) is a neurodegenerative clinical-radiological condition with atrophy of the posterior portions of the cerebral cortex, including the visual cortex and portions of the parietal and temporal cortex. Nonspecific visual disorders are often misinterpreted as ophthalmological leading to a delayed true diagnosis. Differentiating PCA from other diseases can be demanding and time-consuming. A patient with PCA at the age of 57 is shown presenting visual perceptual disorders for years, initially diagnosed as ophthalmic diseases and then as unexplained visual impairment. A radial keratotomy was performed 25 years ago, and six years ago a phakic intraocular verisyse lens was implanted. No suspected optical neuropathy or maculopathy was confirmed during neuroophthalmological observation. Careful medical history reveals that the family noted the patient’s facial recognition, reading and writing difficulties years earlier. The difficulties of estimating depth and spatial orientation, problems with stairs especially when descending were noted. A large discrepancy was found between the reported functional visual impairments (visual acuity, visual field, Ishihara color test) on the one hand, and on the other hand a normal ophthalmoscopic examination on the retina and a normal morphological finding on OCT (Optical Coherence Tomography). The MRI scan also raised suspicion of cortical problems and the patient was directed to further neurological and neuro-radiological observation with PET-FDG leading to the diagnosis of PCA. PCA is an important condition, since these patients usually refer first to ophthalmologists because of visual impairment. Due to normal finding on ophthalmoscopy and normal OCT, they are considered as patients with unexplained visual loss, which is not appropriate. In these cases cortical cause of visual impairment should be considered. Therefore, history data or medical history should be obtained. Sometimes, gathering of comprehensive data pertainingto past and present medical condition from the family members is needed. A specialist in cognitive neurologyshould also be consulted. The aim of this paper is to raise the awareness of physicians about this entity as a possible cause of unexplained vision loss, and to facilitate early recognition with appropriate diagnostic methods.
Keywords (croatian)
NEURODEGENERATIVNE BOLESTI – dijagnostički slikovni prikaz, komplikacije
ATROFIJA – dijagnoza, komplikacije
MOZAK – dijagnostički slikovni prikaz
OKCIPITALNI REŽANJ – patologija
PARIJETALNI REŽANJ – patologija
VIDNI POREMEĆAJI – etiologija
AGNOZIJA – etiologija
ATAKSIJA – etiologija
PERCEPCIJSKI POREMEĆAJI – etiologija
POZITRONSKA EMISIJSKA TOMOGRAFIJA
F-18 FLUORODEOKSIGLUKOZA
MAGNETSKA REZONANCIJA
Keywords (english)
NEURODEGENERATIVE DISEASES – complications, diagnostic imaging
ATROPHY – diagnosis, complications
BRAIN – diagnostic imaging
OCCIPITAL LOBE – pathology
PARIETAL LOBE – pathology
VISION DISORDERS – etiology
AGNOSIA – etiology
ATAXIA – etiology
PERCEPTUAL DISORDERS – etiology
POSITRON-EMISSION TOMOGRAPHY
FLUORODEOXYGLUCOSE F18
MAGNETIC RESONANCE IMAGING
Language croatian Language english Publication type Professional paper - Professional paper Publication status Published Peer review Peer review Publication version Published version Journal title Liječnički vjesnik Numbering vol. 142, no. 9-10, pp. 323-329 p-ISSN 0024-3477 e-ISSN 1849-2177 DOI https://doi.org/10.26800/LV-142-9-10-49 URN:NBN urn:nbn:hr:105:400903 Publication 2020 Document URL https://hrcak.srce.hr/245808 Type of resource Text Access conditions Open access Terms of use Created on 2020-12-04 12:54:04
