Transient cortical blindness following peripheral vascular trauma: A case report

Q4 Medicine Trauma Case Reports Pub Date : 2024-07-29 DOI:10.1016/j.tcr.2024.101083
Dante G. Ang , Siegfredo R. Paloyo , Ferri P. David-Paloyo , Mayou Martin T. Tampo , Emmanuel T. Limpin , Eduardo C. Ayuste Jr
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Abstract

Cortical blindness is characterized by unilateral or bilateral vision loss despite an intact pupillary reflex, full extraocular movements, and normal fundoscopic examination. Common causes include stroke, cardiac emboli, head trauma or rarely, a hypoxic-ischemic event which results to decreased perfusion to the occipital lobes supplied by the posterior cerebral artery. Imaging with computed tomography is usually diagnostic documenting stroke or embolization as well as ensuring an intact cerebral circulation. Prognosis largely depends on the etiology as most reports document an irreversible condition or at least the patient is left with some residual visual symptoms.

We present a case of a 25-year-old male who underwent brachial artery repair with reverse saphenous vein graft interposition after sustaining a right upper arm laceration associated with massive hemorrhage and shock due to delayed consult. He presented with profound bilateral loss of vision 12 h after surgery characterized as right homonymous hemianopsia. Computed tomography of the brain demonstrated ischemic infarcts in the occipital lobes. Close observation was instituted, and his symptom resolved spontaneously within a week. This case highlights the importance of considering atypical causes of perioperative vision loss as early recognition and timely diagnosis are essential to improve patient outcomes. To our knowledge, this is the first report of transient cortical blindness after peripheral vascular trauma.

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外周血管创伤后的短暂皮层失明:病例报告
皮质盲症的特征是,尽管瞳孔反射完好、眼球外运动完全、眼底检查正常,但仍会出现单侧或双侧视力丧失。常见的病因包括中风、心脏栓塞、头部外伤或极少数缺氧缺血性事件导致大脑后动脉供应的枕叶血流灌注减少。计算机断层扫描通常可诊断中风或栓塞,并确保脑循环完好无损。预后在很大程度上取决于病因,因为大多数报告显示这种情况是不可逆的,或者至少患者会留下一些残余的视力症状。我们介绍了一例 25 岁男性患者的病例,他在右上臂撕裂伤后因就诊不及时导致大出血和休克,接受了肱动脉修补术和反向大隐静脉移植插管术。术后 12 小时,他出现双侧视力严重下降,表现为右侧同侧偏盲。脑部计算机断层扫描显示枕叶缺血性梗死。经过密切观察,他的症状在一周内自行缓解。本病例强调了考虑非典型围手术期视力丧失原因的重要性,因为早期识别和及时诊断对改善患者预后至关重要。据我们所知,这是第一例外周血管创伤后短暂性皮层失明的报告。
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来源期刊
Trauma Case Reports
Trauma Case Reports Medicine-Emergency Medicine
CiteScore
0.60
自引率
0.00%
发文量
131
审稿时长
26 weeks
期刊介绍: Trauma Case Reports is the only open access, online journal dedicated to the publication of case reports in all aspects of trauma care and accident surgery. Case reports on all aspects of trauma management, surgical procedures for all tissues, resuscitation, anaesthesia and trauma and tissue healing will be considered for publication by the international editorial team and will be subject to peer review. Bringing together these cases from an international authorship will shed light on surgical problems and help in their effective resolution.
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