SHM Converge Scientific Abstract ePoster Gallery-Chest Pain Free, but Now I Cant See

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A 71-year-old man with coronary artery disease underwent urgent trans-radial coronary angiography and balloon angioplasty for unstable angina and severe in-stent restenosis of the left anterior descending artery. The procedure was performed with midazolam, fentanyl, lidocaine, heparin, aspirin, clopidogrel, and 250 mL of low-osmolar contrast.<br /><br />About one hour later, he developed sudden bilateral, painless partial vision loss. Neurologic examination was otherwise normal. Evaluation for stroke or other acute neurologic injury with CT, CT angiography, MRI, and MR angiography of the brain and neck was negative. There were no signs of an allergic reaction. His vision returned spontaneously within two hours.<br /><br />This case was diagnosed as transient cortical blindness, a rare complication of contrast administration that is more commonly seen after cerebral angiography but can also occur after coronary angiography. The exact mechanism is unclear, but proposed causes include contrast crossing a disrupted blood-brain barrier and causing transient neurotoxicity, especially in the occipital cortex. Symptoms usually begin within hours of contrast exposure and resolve completely within hours to days without lasting deficits.<br /><br />Preventive strategies are not well established, but minimizing contrast volume and possibly using hyperosmolar agents may reduce risk. Control of vascular and inflammatory risk factors may also help. Overall, the condition is rare, self-limited, and treated supportively, with an excellent prognosis.

Asset Subtitle

Hesham Elmariah

Meta Tag

Author List Anand Shukla, Esha Vaish, Hesham Elmariah, Lucy Zheng, Roma Patel, Sonia Mehra

Category Clinical Vignettes

Concept Transient Cortical Blindness

Concept Bilateral vision loss

Concept Coronary Angiography

Concept Contrast Agent

Concept Stroke

Distinguished Non-Finalist

Presenter Organization Mount Sinai Beth Israel

Presenting Author Hesham Elmariah

Track Adult

Keywords

transient cortical blindness

coronary angiography

contrast administration

partial vision loss

in-stent restenosis

unstable angina

low-osmolar contrast

occipital cortex

neurotoxicity

balloon angioplasty

Transient Cortical Blindness

Bilateral vision loss

Coronary Angiography

Contrast Agent

Stroke