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Neurological picture
Retinal red spots and white-matter lesions in a 60-year-old man
  1. Floor E Jansen1,
  2. Mary J van Schooneveld2,
  3. Catharina J M Frijns1
  1. 1Rudolph Magnus Institute of Neuroscience, Department of Neurology, University Medical Centre, Utrecht, The Netherlands
  2. 2Department of Ophthalmology, University Medical Centre, Utrecht, The Netherlands
  1. Correspondence to Dr Floor E Jansen, Department of Neurology, KC03.036.0, University Medical Centre, Lundlaan 6, Utrecht 3584 AE, The Netherlands; f.e.jansen{at}umcutrecht.nl

https://doi.org/10.1136/jnnp.2009.186056

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    A 60-year-old man presented in 2007 with slowly progressive dysarthria, weakness of the facial muscles and difficulty swallowing, which started 1 year before he was referred to our hospital with a diagnosis of multiple sclerosis. The medical history revealed decreased vision caused by a severe occlusive retinopathy (figure 1), hypertension, mild renal failure and Raynaud phenomenon. At neurological examination, we noticed a pseudobulbar dysarthria, and weakness of the facial muscles and tongue. Pseudobulbar reflexes could be elicited. Arms and legs were unaffected. Gait was a little slow but otherwise undisturbed.

    Figure 1

    Right eye of the patient with typical extensive capillary closure in the macular area and slight leakage of fluorescein from the optic disc resulting from slight neovascularisation.

    Cerebral MRI showed bilateral subcortical white-matter lesions underlying …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.