Transient visual disturbance during cardiac catheterization with angiography

Abstract

The occurrence of visual disturbances following cardiac catheterization with angiographies was studied in a prospective study of 2,006 consecutive adult patients. The overall incidence of visual disturbances was 1.0% and of complete blindness 0.2%. Women had higher incidence than men (2.0 versus 0.6%, p less than 0.01) and patients with a history of angina pectoris with normal coronary arteries had higher incidence than those with coronary artery stenosis (3.7 versus 0.8%, p less than 0.02). Thirteen of twenty patients also had signs of mental confusion. An abnormal electroencephalogram was found in 8 of 13 patients studied. Other neurological findings were observed in one patient only. All patients had complete recovery within 24 hours. Thus, the incidence of visual disturbances is found to be higher than earlier reported, but the visual loss is transient with a benign course.

Two cases of occipital infarction following cardiac catheterization.

“…The most comprehensive analysis, a prospective series of 2,006 cases undergoing cardiac catheterization, reported a total of 20 patients (1%) who experienced transient visual disturbances. 7 The incidence was higher in women (2%, 11 of 548) than in men (0.6%, 9 of 1,458). The visual disturbance was recognized within the first hour following catheterization, and all patients had a complete recovery within 24 hours.…”

“…Occipital lobe ischemia may result from 1) dislodgment of atheromatous material, 2) embolization of thrombus from the catheter tip, 3) in situ thrombosis or spasm of cerebral vessels, 4) a hypotensive episode, 5) preexisting hypertensive disease or migraine headaches, or 6) selective vulnerability of occipital lobes to contrast media toxicity. 7 Of 20 patients studied prospectivery, the incidence of transient visual disturbance appeared to be significantly higher in patients with normal coronary arteries (3.7% vs. 0.8%). 7 If presence of atheromatous coronary artery disease is taken as a marker of atherosclerosis elsewhere, dislodgment of atheromatous material causing blindness would appear to be a less likely mechanism.…”

“…7 Of 20 patients studied prospectivery, the incidence of transient visual disturbance appeared to be significantly higher in patients with normal coronary arteries (3.7% vs. 0.8%). 7 If presence of atheromatous coronary artery disease is taken as a marker of atherosclerosis elsewhere, dislodgment of atheromatous material causing blindness would appear to be a less likely mechanism. Although hypotension may be a contributing factor, only one patient developed a visual disturbance during transient hypotension.…”

“…8 Another patient had transient hypotension that was treated and then developed visual loss with documented normal blood pressure. 7 The other mechanisms suggested may indeed play significant roles; however, none of these has ever been demonstrated radiologicalry or pathologically.…”

“…15 Several mechanisms have been proposed to explain the clinical findings, and similar mechanisms may explain the transient visual disturbances after cardiac catheterization. 7 Blindness results presumably from occipital lobe ischemia. Somnolence, commonly seen in "top of the basilar" syndrome, 16 frequently accompanies postcatheterization visual disturbances and suggests ischemia to the rostral brainstem.…”