125 Complex cortical visual impairments following bilateral occipital infarcts after traumatic brain injury

Abstract

BackgroundSecondary brain damage following acute traumatic brain injury (TBI) contributes to increased morbidity and disability. Intracranial vasospasm is a less common cause for secondary brain damage. We report a case of a 73 year old man in whom post-traumatic vasospasm lead to bilateral occipital infarction.Case summaryThe patient was admitted with a severe TBI following a fall from height causing bilateral fronto-temporal haemorrhagic contusions. Ten days after admission he developed a fluctuating level of consciousness. Repeat cranial CT and angiography showed new bilateral occipital hypodensities and bilaterally multi-level vessel narrowing in the posterior circulation.The patient suffered from cortical blindness but regained gradually visual perceptual function over the next months. During this time a combination of Balint syndrome (simultanagnosia, oculomotor apraxia and optic ataxia), visual hallucinations and confabulation were observed. Neurorehabilitation was com- plicated by the complex nature of extensive cognitive deficit in combination with the visual impairments but enabled the patient to gain some insight and coping strategies.ConclusionsThis case highlights the complexities of neurorehabilitation following TBI and describes an unusual case of partially reversible cortical blindness. It further highlights the importance of recognising the impact of secondary brain damage after TBI.nicole.lichtblau@nhs.net