Transient Cortical Blindness Following Bypass Graft Angiography

Abstract

Transient cortical blindness, an uncommonly recognized complication of cerebral angiography, is an exceedingly rare event after cardiac catheterization and angiography. This report describes a sixty-two-year-old patient who had transient cortical blindness following bypass graft angiography. In this case, the authors showed that cortical blindness was associated with the breakage of the blood-brain barrier (BBB) and an increase in vascular permeability rather than with primary cerebral circulatory insufficiency. When the possibility exists that an excess volume of contrast medium may enter the cerebral circulation as in this case, that is, following a coronary artery bypass graft (CABG) using the internal mammary artery (IMA), precautionary measures may be necessary such as changing the type of contrast medium to be used or decreasing the volume injected. When cortical blindness occurs, it is a serious clinical problem whether transient or permanent. Therefore, the circumstances leading to this complication should be understood to determine suitable treatment and management.

Safety of coronary arteriography in clinically stable patients following coronary bypass surgery

“…Neurologic complications during cardiac catheterization are usually due to catheter-or guidewire-induced emboli from the left ventricle or ascending aorta [3,4,7,[9][10][11]. Some neurologic complications may be directly related to the effect of the contrast material on the brain but these tend to be transient [12]. In this study, all patients had hyperlipidemia to varying degrees and it is possible, therefore, that atheroma were present in the ascending aorta [9,10].…”

Transient Cortical Blindness in a 15 Year Old Boy : A Case Report

“…Visual loss after surgery is caused primarily due to emboli, severe low blood pressure, acute anemia, hypoxia or a combination of these factors. 1,6 Cortical blindness may be a resultant of severe and prolonged hypotension or embolism/thrombosis from heart, aortic arch or carotid vertebra-basilar artery during or postsurgery as described by Kamata J et al 7 . In most cases complete recovery occurs.…”

Transient cortical blindness after heart surgery in a child patient -A case report-

“…Direct pressure on the eyeball, indirect increase in ocular tension due to improper positioning and blood vessel damage can cause central retinal artery occlusion or ischemic optic nerve damage, which can lead to visual loss [1,7]. In addition, a severe decrease in blood pressure, emboli, and thrombus mid- or post-surgery can cause an infarction in the occipital cortex, which can lead to cortical blindness [8,9]. Post-surgery visual loss can be caused by a range of factors.…”

“…Aldrich et al [3] reported a retrospective study of 25 patients, where the causes of cortical blindness were natural ischemic stroke in 8 patients (32%), cardiac surgery in 5 patients (20%), cerebral angiography in 3 patients (12%), non-surgery in 4 patients (16%), seizure in 2 patients (8%), and other factors, such as damage to the head and peritoneal dialysis, in 3 patients (12%). There were also cases of temporary cortical blindness reported after post-cardiac surgery angiography [8]. …”