Transient Cortical Blindness Related to General Anesthesia

ABSTRACT

PURPOSE: We report a case of cortical blindness due to transient cerebral ischemia associated with general anesthesia. METHODS: A 45 year-old woman complained of bilateral visual loss after emergent incision and drainage for the treatment of extensive pyogenic abscess around the left mandibular space causing severe respiratory distress, and transient cerebral ischemia due to difficult tracheal intubation. At first ophthalmologic examination, 8 days after the operation, visual acuity was hand movement. Functions of external ocular muscles, blinking reflex, accommodation, pupillary light reflex, color vision test, intraocular pressure, and the findings of anterior segment, optic nerve and fundus were normal. Humphrey visual field examination showed nonspecific visual field defect, and pattern visual evoked potential examiantion showed flattening of waveforms. Both brain magnetic resonance imaging and electroencephalography were normal. However, brain single positron emission computerized tomography demonstrated general decrease of blood perfusion in the cerebrum including the occipital lobes. RESULTS: Without any specific treatment, her vision improved gradually, and 6 weeks after operation, it was 0.4 in the right and 0.7 in the left eye. After 3 months, it was 0.9, and no other abnormal ocular findings were noted on both eyes. CONCLUSIONS: Cortical blindness can occur by transient cerebral ischemia associated with general anesthesia, and its visual prognosis may be good.