Internal Medicine & Patient Care

Biography

Abstract

Introduction: Transient cortical blindness after contrast-induced media is an extremely rare occurrence. It has been estimated that approximately 1% of the patients suffer cortical blindness after undergoing a cerebral or vertebral angiography. Based on our literature review only 18 documented cases have been reported of transient cortical blindness secondary to coronary angiography using modern, non-ionic, low-osmolality based contrast agents. We present a case of an elderly man with symptomatic bradycardia who underwent dual-chamber permanent pacemaker implantation that had transient contrast induced cortical blindness.

 

Case Report:  Patient is a 77-year-old male truck driver with a past medical history of hyperlipidemia that presents to our hospital after a syncopal episode that resulted in left rib pain.  He reported loss of consciousness after drinking several beers and felt as if the room was spinning around him. He denied any postictal confusion, loss of urinary or bowel incontinence.  CT scan of the chest was done which showed 4th and 5th rib fractures. On EKG his heart rate was 47 beats per minute with a new onset of right bundle branch block with no ST segment changes. His 2-D echocardiogram and troponins were within normal limits. He underwent a tilt table study, which showed classic mixed cardioinhibitory and vasodepressor response, with heart rate in 20’s, consistent with neurocardiogenic syncope. Based on these findings, a dual chamber cardiac pacemaker was implanted successfully, without any complications.  Agents that were used during the procedure-included lidocaine for local anesthesia, and low osmolality, non ionic iodine based contrast. Approximately 1 hour after the procedure the patient started to experience blurred vision, which soon progressed to bilateral blindness. On examination, his fundoscopic examination was normal, and no neurological deficit was present except for blindness. Since he was not a candidate for an MRI, he underwent head/neck CTA that was within normal limits. Next day at 1:30 am the patient started to notice improvement in his vision and by 9:00 am his vision was restored back to normal. Based on this clinical picture it was concluded that his transient bilateral loss of vision was contrast induced. Patient was soon after safely discharged from the hospital.

 

Conclusion: Contrast induced cortical blindness is an extremely rare finding. This is an excellent case to inform healthcare professionals of a potential serious side effect from a commonly used agent. There is no specific measure that needs to be taken for protection against this unusual and alarming complication. Careful neurological assessment and consultation accompanied by MRI or CT scanning can confirm the diagnosis. When these agents cause cortical blindness it is anticipated it takes 24-72 hours for resolution back to normal vision.