A Case of Acquired Cerebral Achromatopsia Secondary to Posterior Cerebral Artery Stroke.

Impairment of color vision is known as "Achromatopsia." This condition is multifactorial with a myriad of causes, from local at the retinal level to central at the occipital cortex level. The most common causes are inherited conditions. However, acquired achromatopsia has been acknowledged in numerous case reports and studies. Achromatopsia secondary to posterior cerebral artery (PCA) stroke is an extremely rare phenomenon and had been reported in a few case reports. In this case, we report a patient presenting with achromatopsia as the only complaint due to an infarction of the left occipital cortex.

Cerebral Venous Sinus Thrombosis in an Immunocompetent HIV Patient.

Cerebral venous sinus thrombosis (CVST) is an uncommon manifestation in patients with the human immunodeficiency virus (HIV) due to the virus's prothrombotic state. Our case involves a 41-year-old Hispanic male with a past medical history of HIV on bictegravir/emtricitabine/tenofovir/alafenamide (Biktarvy), hyperlipidemia, post-traumatic stress disorder, hypogonadism with the cessation of testosterone injections one month prior, and generalized anxiety disorder who presented with retro-orbital headache, intermittent bilateral blurry vision, and flashing lights in the lower lateral left eye for one week. Vitals signs and laboratory studies were within normal limits aside from new iron deficiency anemia. Neurological exam was unremarkable. Computed tomography (CT) of the head showed evidence of a subacute cerebral infarct with hemorrhagic transformation in the right superior parietal lobe. Magnetic resonance imaging (MRI) of the brain with contrast revealed a small thrombosed cortical vein with surrounding hemorrhage and edema in the same location, in addition to a partial thrombosis of the adjacent superior sagittal sinus, which was confirmed by magnetic resonance venogram (MRV). Although cerebral angiography was performed, no intervention was attempted for the partially occluded sagittal sinus. HIV viral load was undetectable with a robust cluster of differentiation (CD) 4 count on therapy. The patient was treated with strict blood pressure control, a statin, and a heparin drip. He remained stable and was discharged on enoxaparin injections with bridging to warfarin. In summary, appropriate lab testing, imaging, and high clinical suspicion are required for proper diagnosis and treatment of venous thromboembolism (VTE) or CVST in an HIV-positive patient.