Posterior reversible encephalopathy syndrome presenting as sudden bilateral vision loss

This is the case of a 60-year-old woman admitted to the hospital for allogeneic stem cell transplant who had sudden onset bilateral vision loss. Her initial ophthalmologic exam was remarkable for optic nerve pallor and nystagmus; however she then had a seizure and was upgraded to the intensive care unit. Her imaging revealed findings indicative of posterior reversible encephalopathy syndrome, which was likely secondary to cyclosporine toxicity. After stopping cyclosporine, the patient\u27s clinical status improved and she regained vision.[1] BCSC Section 5. Neuro-Ophthalmology; [2] Zelaya JE, Al-Khoury L. Posterior Reversible Encephalopathy Syndrome. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554492/; [3] El Salloukh NA, Hage DG, Bashshur AZ, Kheir WJ. Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives. Clin Ophthalmol. 2022 Jul 1;16:2119-2127. doi: 10.2147/OPTH.S342720. PMID: 35800672; PMCID: PMC9255417.; [4] Helal J Jr, Malerbi FK, Melaragno Filho R. Trombose de veia central da retina bilateral associada à síndrome de hiperviscosidade sanguínea--relato de caso [Bilateral central retinal vein occlusion associated with blood hyperviscosity syndrome--case report]. Arq Bras Oftalmol. 2005 Jan-Feb;68(1):126-8. Portuguese. doi: 10.1590/s0004-27492005000100023. Epub 2005 Mar 30. PMID: 15824817.; [5] Bartynski WS, Boardman JF. Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol. 2007;28 (7): 1320-7. doi:10.3174/ajnr.A0549; [6] Lifson N, Pasquale A, Salloum G, Alpert S. Ophthalmic Manifestations of Posterior Reversible Encephalopathy Syndrome. Neuroophthalmology. 2018 Aug 17;43(3):180-184. doi: 10.1080/01658107.2018.1506938. PMID: 31312242; PMCID: PMC6619982.; [7] Singer S, Grommes C, Reiner AS, Rosenblum MK, DeAngelis LM. Posterior Reversible Encephalopathy Syndrome in Patients With Cancer. Oncologist. 2015 Jul;20(7):806-11. doi: 10.1634/theoncologist.2014-0149. Epub 2015 Jun 1. PMID: 26032137; PMCID: PMC4492224.; [8] Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017 Aug;264(8):1608-1616. doi: 10.1007/s00415-016-8377-8. Epub 2017 Jan 4. PMID: 28054130; PMCID: PMC5533845