Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2025; 13(27): 108868
Published online Sep 26, 2025. doi: 10.12998/wjcc.v13.i27.108868
Ishihara color plates utilized as an assessment for simultanagnosia in posterior cortical atrophy: A case report
Francesco Pellegrini, Alessandra Cuna, Mutali Musa, Fabiana D’Esposito, Rosa Giglio, Daniele Tognetto, Caterina Gagliano, Marco Zeppieri
Francesco Pellegrini, Department of Ophthalmology, ASFO Pordenone Hospital, Pordenone, Italy, Pordenone 33170, Italy
Alessandra Cuna, Department of Ophthalmology, “De Gironcoli” Hospital, AULSS2 Marca Trevigiana, Conegliano 31100, Italy
Mutali Musa, Department of Optometry, University of Benin, Benin 300283, Nigeria
Mutali Musa, Department of Ophthalmology, Africa Eye Laser Center Ltd, Benin 300211, Nigeria
Fabiana D’Esposito, Imperial College Ophthalmic Research Group Unit, Imperial College, London NW1 5QH, United Kingdom
Fabiana D’Esposito, Caterina Gagliano, Department of Medicine and Surgery, University of Enna "Kore", Enna 94100, Italy
Rosa Giglio, Daniele Tognetto, Marco Zeppieri, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34129, Italy
Caterina Gagliano, Mediterranean Foundation, “G.B. Morgagni”, Catania 95100, Italy
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Co-first authors: Francesco Pellegrini and Alessandra Cuna.
Co-corresponding authors: Caterina Gagliano and Marco Zeppieri.
Author contributions: Pellegrini F and Cuna A wrote the outline; Pellegrini F, Cuna A, Gagliano C and Zeppieri M performed the research and wrote the manuscript; Gagliano C, Zeppieri M and Musa M assisted in the writing of the draft and final paper; Pellegrini F and Cuna A were responsible for study conception and design; D’Esposito F, Giglio R, Tognetto D, Gagliano C, Musa M and Zeppieri M assisted in the research, writing and editing of the manuscript; Gagliano C and Zeppieri A contributed to the scientific editing; D’Esposito F, Giglio R, Tognetto D, Gagliano C, Musa M and Zeppieri M assisted in the editing of the manuscript, making critical revisions and viewing all versions of the manuscript; All authors provided final approval of the article.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Zeppieri, MD, PhD, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria Della Misericordia 15, Udine 33100, Italy. mark.zeppieri@asufc.sanita.fvg.it
Received: April 24, 2025
Revised: May 19, 2025
Accepted: June 18, 2025
Published online: September 26, 2025
Processing time: 103 Days and 0.1 Hours
Abstract
BACKGROUND

Simultanagnosia is a neurological disorder that impairs an individual's ability to perceive more than one object at a time visually. While the individual may acknowledge the presence of multiple objects in his field of view, he cannot generally summarize the overall percept.

CASE SUMMARY

We describe a case of simultanagnosia in Posterior Cortical Atrophy, evidenced by the Ishihara color test. A 54-year-old woman complained of reading problems despite normal visual acuity and a structural eye exam. The patient failed to identify any of the Ishihara color plates in either eye despite adequate naming of colors. Automated visual field testing showed a homonymous hemianopia. Structural and functional neuroimaging and cerebrospinal fluid analysis were consistent with posterior cortical atrophy.

CONCLUSION

Simultanagnosia can be tested with the Ishihara pseudoisochromatic plates because the recognition of embedded number patterns in the test requires appreciation of a collection of individual stimuli.

Keywords: Simultanagnosia; Posterior cortical atrophy; Color vision; Benson syndrome; Ishihara color plates; Case report

Core Tip: The Isihara pseudoisochromatic plate is a commonly available non-invasive, subjective test for color vision. The diagnosis of simultanagnosia relies on the subjective responses of the likely sufferer to visual stimuli. Therefore, the Isihara test plates offer a novel way of diagnosing this condition. A knowledge of the response of simultanagnostic patients can potentially guide diagnosis when performing standard color vision testing using Isihara test plates.