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Fatal Ischemic Stroke Complicating Acute Multifocal Placoid Pigment Epitheliopathy: Histopathological Findings

Tsang, Benjamin K.-T. MBBS, BPharm; Chauhan, Devinder S. MBBS, MD, FRCOphth, FRANZCO; Haward, Rebecca MBBS; Whiteman, Ida MBBS; Frayne, Judith MBBS, FRACP; McLean, Catriona BSc, MBBS, FRCPA, MD

Journal of Neuro-Ophthalmology: March 2014 - Volume 34 - Issue 1 - p 10–15
doi: 10.1097/WNO.0b013e318294a4b0
Original Contribution

Abstract: A previously healthy 29-year-old man was admitted to a tertiary referral center with acute left hemiparesis followed shortly by de novo convulsive status epilepticus. This was in the context of a 2-month history of flu-like symptoms, severe headaches, and retinopathy recently diagnosed as acute multifocal placoid pigment epitheliopathy. Neuroimaging demonstrated bilateral, multiple territory cerebral infarction. Despite intravenous methylprednisolone and craniotomy for the management of raised intracranial pressure, the patient deteriorated and died 14 days later. At autopsy, multiple infarcts of varying ages within a 10-day period were seen in association with a segmental giant cell vasculopathy of meningeal arteries.

Department of Neurosciences (BK-TT, JF), Alfred Health, Victoria, Australia; Vision Retinal Institute Eastern (DSC), Box Hill, Victoria, Australia; Departments of Ophthalmology (RH) and Anatomical Pathology (CM), Alfred Health, Victoria, Australia.

Address correspondence to Benjamin K.-T. Tsang, MBBS, BPharm, Department of Neurosciences, Alfred Health, Commercial Road, Prahran 3181, Victoria, Australia; E-mail:

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society