Transient cortical blindness after coronary artery angiography

Abstract

Coronary angiography is the current gold standard for the diagnosis of ischemic heart disease and therefore the prevalence of percutaneous coronary procedures such as angiography and angioplasty is high. The occurrence of cerebral complications after coronary angiography and coronary angioplasty is low and it mainly includes transient ischemic attack and stroke. The prevalence of transient cortical blindness after X-ray contrast media is low and it is usually seen after cerebral angiography. Until now only a few cases of transient cortical blindness have been described after coronary artery angiography. Regarding the spread of coronary angiography worldwide and in Poland this complication is uniquely rare. A 32-year-old man with multiple extrasystolic ventricular arrhythmia suggesting Brugada syndrome diagnosis according to morphology of the left bundle branch block and with decreased left ventricular ejection fraction was admitted to the First Department of Cardiology and Hypertension, Medical College of the Jagiellonian University in Krakow. Coronary angiography was performed in order to exclude ischemic etiology of the observed abnormalities. No arteriosclerotic lesions were found in coronary arteries. Transient cortical blindness was observed directly after angiography which may have been caused by the neurotoxic effect of the used X-ray contrast medium. In ophthalmologic and neurologic examination as well as in the cerebral computed tomography scan no pathologies were found. Visual impairment disappeared totally within several hours.

Contrast‐induced encephalopathy following cardiac catheterization

“…From the search results, we identified five case series and 38 case reports , for a total of 52 patients. The first published report documenting presumed CIE associated with cardiac catheterization dates from 1970 .…”

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

“…Some researchers have demonstrated that contrast agents may induce vasodilation, shrinkage of cerebrovascular endothelial cells, and widened endothelial tight junctions (13–15). Moreover, previous studies found that the risk of transient cortical blindness increases when the contrast agent in the cerebral circulation is higher (9, 16). A higher dose of contrast agent could prolong the duration of exposure of the cerebrovascular endothelium to the contrast agent by increasing the transit time, thus resulting in blood–brain barrier breakdown, which would further increase the transfer of contrast material (17).…”

Bilateral cortical blindness after recurrent ischemic stroke

“…In the literature, cortical blindness and transient cortical blindness have also been reported which developed after coronary angiography intervention or cardiopulmonary resuscitation [6,7]. What distinguished our case from other cases is that the onset of the stroke affected the right visual field a year ago and newly developed stroke affected the left visual field which resulted in cortical bilateral total vision loss.…”