Transient Cortical Blindness: a Rare Complication After Cerebral Digital Subtraction Angiography

Abstract

Transient cortical blindness (TCB) is a rare complication after cerebral or coronary angiography. In this article, we elaborate the condition and present a case which occurred in our hospital. With increasing numbers of diagnostic angiographies and endovascular interventions, we want to raise awareness of TCB and its clinical course. We report about a 57-year-old woman with TCB after a diagnostic digital subtraction angiography (DSA) and endovascular treatment of a ruptured aneurysm of the basilar tip. Symptoms disappeared spontaneously after 36 h with no residual deficits. Multimodal imaging including non-contrast enhanced cerebral CT-scan (NECT), cerebral magnetic resonance imaging (cMRI), and cerebral DSA are presented. Despite the seemingly grave event, the prognosis of this condition can be considered as excellent. The exact pathophysiology remains speculative, but might be related to contrast agent neurotoxicity with transient disruption of blood brain barrier integrity. Immediate computed tomographic angiogram (CTA) and CT-scan or magnetic resonance angiography (MRA) and cMRI should be performed after an occurrence of a suspected TCB to rule out embolic occlusions or hemorrhage. The administration of steroids can be considered.

Transient cortical blindness, a rare complication during cerebral digital subtraction angiography: A case report and literature review

“…The symptoms of TCB can begin as soon as the contrast agent is injected, and they can take up to 24 h to appear 5 . Bilateral visual loss has been reported in a number of case reports as noted in the current case 6–8 …”

“… 5 Bilateral visual loss has been reported in a number of case reports as noted in the current case. 6 , 7 , 8 The index case experienced in addition, tonic seizure, tinnitus, horizontal nystagmus, and incoherent speech. The recovery of normal vision and symptoms may range from few hours, as in the index case of 1 h to about 5 days.…”

Transient Cortical Blindness, a Rare Complication During Cerebral Digital Subtraction Angiography: A Case Report and Literature review

“…The symptoms of TCB may start immediately after contrast agent injection and upto 24hours (5). Bilateral visual loss has been reported in a number of case reports as noted in the current case (6)(7)(8).The index case experienced in addition, tonic seizure, tinnitus, horizontal nystagmus and incoherent speech. The recovery of normal vision and symptoms may range from few hours, as in the index case of one hour to about 5days (7,9,10).…”

Contrast-induced encephalopathy

“…Transient vision impairment was fi rst described in 1952 after a cerebral angiography with diodrast (2-(3,5-diiodo-4-oxopyridin-1-yl) acetate or iodopyracet), an ionic monomer (8). Several case reports describing similar symptoms after the application of iodinated contrast agents have subsequently been published (10)(11)(12)(13)(14).…”

“…Cerebral oedema was observed in some cases. These radiological fi ndings together with clinical signs of neurological disorder subside within few hours to days (5,7,11,14,16,17,18,20,21,(34)(35)(36). The study of multiple cases of cortical blindness after a cerebral angiography with non-ionic iodinated contrast agents has reported the presence of MRI hyperintensities in the parietooccipital region (19).…”