We describe a case of posterior cortical atrophy presenting with progressive visuoperceptual and visuospatial difficulties, but with no abnormalities on standard ophthalmological examination.

Case report

The patient, a 53 year old right handed woman, with well controlled primary generalised epilepsy, presented to her optometrist with a 1 year history of deterioration in vision. She had particular difficulties with walking downstairs and following text while reading. She could read 6/12+2 RE (with −0.75/−0.25×90 correction) and 6/12+3 (with −0.75 correction) LE. With +2.25 correction she could read N5 slowly with each eye. On subsequent ophthalmological review no significant abnormality was found on examination and no specific diagnosis was made.

Over the following months her vision deteriorated. She reported difficulties following a line while writing and was unable to tell when a glass was full when pouring a drink. Her husband thought that she was unable to see things in her peripheral vision. This culminated in her crashing her car. She did not have any memory difficulties, she had preserved insight, …