Purtscher's retinopathy after a rally-driving accident.

A 31-year-old man was a driver in a rally when his car hit a concrete block at approximately 100 km/h. He lost consciousness for an unknown number of minutes. His helmet was split. He had no external signs of injury; his Glasgow Coma Scale was 15 and computed tomography of the brain was normal. His vision gradually deteriorated over the following 6 days. He had no history of ophthalmic problems, including ambylopia. His best corrected visual acuities were hand movements in each eye. There was no relative afferent pupillary defect but dilated fundal examination revealed multiple, almost confluent, cotton wool spots around both optic discs with some slivers of retinal haemorrhage (Figure 1). Purtscher's retinopathy was diagnosed and the patient was counselled regarding the uncertain visual prognosis. His vision improved; 18 days later his visual acuities were 6/9 unaided in each eye, and the cotton wool spots were reducing (Figure 2).