Paracentral Acute Middle Maculopathy after Severe Headache

ABSTRACT

Purpose@#We report the first case of bilateral paracentral acute middle maculopathy (PAMM) after severe headache in a Korean patient.Case summary: A 43-year-old woman with herniation of a lumbar disk visited the emergency room with a 5-day history of headache and bilateral visual disturbance. She experienced a severe headache, facial fever, and partial visual field defects in both eyes. There were no neurologic symptoms, related acute brain disease or lesions on brain/orbit magnetic resonance imaging.Her best corrected visual acuity was 0.8 (right eye) and 0.5 (left eye), which was lower than. There were no relative afferent pupillary defects, color deficits, or any ocular movement disorder. Her intraocular pressures were normal, but a Humphrey visual field test identified multiple atypical scotomas in both eyes. Ophthalmoscopic examination revealed multiple light gray exudates with unclear margins surrounding the maculas of both eyes. Spectral domain optical coherence tomography (SD-OCT) showed some localized hyper-reflective lesions located in the inner plexiform, inner nuclear, and outer plexiform layers. On optical coherence tomography angiography (OCTA) examination, there was a normal choriocapillaris and a reduction of the inner retinal capillary plexus corresponding to the lesions in the fundus examination. Fluorescent angiography revealed early localized nonperfusion areas and a late leak in the same lesions. In addition, there was delayed filling of the peripheral retina and a late leak. @*Conclusions@#It is important to consider PAMM in patients who show sudden visual loss or visual field defects and SD-OCT and OCTA may assist in the diagnosis.