Cortical blindness after catheter angiography

Neurotoxicity Associated with Radiological Contrast Agents Used during Coronary Angiography: A Systematic Review

Contrast media enhances the visualization of the anatomic structures in radiological studies, allowing internal tissues such as blood vessels, kidney, ureters, adrenals and other organs to be identified. The evolution of contrast media highlights the efforts to develop less toxic chemical agents that possess low viscosity and osmolality. However, adverse effects such as idiosyncratic reactions, and organ specific damage are well characterized. Neurotoxicity, an important and dose related effect, appears to be due to disruption of the blood-brain-barrier by the high osmolarity of the contrast agent. From devastating cortical blindness to paralysis and seizures, an array of neurological manifestations has been described. In this systematic review, we describe the contrast-induced neurologic injury following coronary angiography and discuss the proposed mechanisms of injury leading to neurotoxicity.

Risk Factors of Transient Cortical Blindness After Cerebral Angiography: A Multicenter Study

Background: Although transient cortical blindness is a rare complication following cerebral angiography, identification of risk factors for the development of transient cortical blindness after cerebral angiography is an important clinical issue. Material and methods: Between January 2008 and April 2018, 5,126 patients at five high-volume medical centers who underwent cerebral angiography procedures were enrolled in this multicenter cohort study. Patient baseline characteristics and surgery-related factors were analyzed. We used multivariate logistic regression to examine factors associated with transient cortical blindness. Results: Eighteen patients (0.35%) in the total cohort of 5,126 suffered transient cortical blindness. After univariate statistical analysis, no significant differences were determined between the transient cortical blindness group and the control group regarding gender (p = 0.454), age (p = 0.872), smoking (p = 0.170), diabetes (p = 0.800), and hypertension (p = 0.100). Compared with the control group, the transient cortical blindness group weighed less (p = 0.020), and had a larger dose of contrast agent (p = 0.034) and more instances of contrast agent injected into the posterior circulation (p < 0.001). Logistic regression analysis identified contrast agent dose and contrast agent injected into posterior circulation as independent predictive factors for transient cortical blindness (P < 0.05). Conclusion: Larger doses off contrast agent and contrast agent injected into the posterior circulation are potential independent predictive factors for transient cortical blindness following cerebral angiography.

Transient cortical blindness after thoracic endovascular aneurysm repair

We report a patient who presented with transient cortical blindness 12 hours after completion of a thoracic endovascular aneurysm repair. Computed tomography of the brain demonstrated no acute findings. The patient's symptoms resolved spontaneously after 72 hours. To our knowledge, this is the first report of transient cortical blindness after endovascular aortic aneurysm repair. This is an uncommon diagnosis that is important to recognize in a modern vascular surgery practice.

Reversible cortical blindness following successful surgical repair of two stab wounds in the heart

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest (shock and low cardiac output status), following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle, and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly, but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy, Electroencephalograms (EEGs) and Computed Tomography Scans revealed no abnormalities, apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later, the patient regained his vision gradually and was discharged on the 7^th postoperative day without any remarks.