Upside down words as initial clinical presentation of an underlying acute ischemic stroke

ABSTRACT

@#We report a diabetic patient who was diagnosed with an acute stroke who presented with a 3-day history of difficulty of reading, described as the words were turned upside down, as if the words were inverted horizontally with associated right homonymous hemianopia and multiple higher cortical function deficits (alexia without agraphia, achromatopsia, prosopagnosia). He has poorly controlled diabetes and hypertension. Cranial magnetic resonance imaging (MRI) revealed an acute infarct on the left posterior cerebral artery territory. The patient was managed as an acute ischemic stroke and follow up after 6 months revealed improvement of the visual field cut but with persistence of the higher cortical function deficits. To the best of our knowledge, we report the first rare occurrence reversal of vision metamorphopsia described as inverted words as the sole initial presentation of an underlying stroke.