Altitudinal Visual Field Defects Following Diagnostic Transfemoral Cerebral Angiography.

Kyungwoo Yoon,Soo Young Chae,Kiyoung Kim

doi:10.3390/medicina57060567

Abstract

Transfemoral cerebral angiography (TFCA) has been increasingly used as diagnostic method for the evaluation of cerebral vessels. Ophthalmologic complication after TFCA has rarely been reported, and most complications are associated with an intraoperative thrombo-embolic event. We reported a patient who developed a superior altitudinal visual field defect one day after diagnostic TFCA. The ophthalmic exam revealed a prominent inferior optic disc edema, and the fluorescein angiographic showed the non-perfusion of the corresponding inferior sectoral optic disc. Diffusion-weighted MRI on the day following cerebral angiography revealed multiple focal scattered acute infarctions. Even one month after steroid pulse therapy, the superior nasal field defect remained with minimal improvement. We believe this case was consistent with an acute anterior ischemic optic neuropathy (AION) due to thrombo-embolism after TFCA. Ophthalmic examinations and a visual field test should be performed before and immediately after the TFCA, particularly in the case with a high risk of thromboembolic events.

Highlights

Cerebral digital subtraction angiography (DSA) is an endovascular diagnostic procedure used to evaluate intracranial aneurysm, subarachnoid hemorrhage (SAH), stroke, and arteriovenous malformations
The incidence of neurological complications following cerebral DSA occurred in 2.63%, especially ophthalmic complications, which constituted 0.24% [1]
The reasons for these complications are not completely understood; intraoperative ischemic events can be caused by microemboli, which are confirmed by lesions on diffusion-weighted MRI (DWI) or intraoperative transcranial Doppler [2]

Summary

Introduction

Cerebral digital subtraction angiography (DSA) is an endovascular diagnostic procedure used to evaluate intracranial aneurysm, subarachnoid hemorrhage (SAH), stroke, and arteriovenous malformations. 2. Case Presentation A 59-year-old woman underwent transfemoral cerebral angiography (TFCA) for a follow-up evaluation of previously treated intracranial aneurysms. Case Presentation A 59-year-old woman underwent transfemoral cerebral angiography (TFCA) for a follow-up evaluation of previously treated intracranial aneurysms She had a history of SAH secondary to the left posterior communicating artery (PCOM) aneurysm that was treated with coil embolization 7 years prior. Medicina 2021, 57, 567 A 59-year-old woman underwent transfemoral cerebral angiography (TFCA) for a follow-up evaluation of previously treated intracranial aneurysms. Medicina 2021, 57, 567 were initially found one day following TFCA. (C) Seven days after TFCA, steroid pulse therapy was completed, and optic disc edema was slightly resolved. (D) Thirty days after TFCA, optic disc edema and peripapillary lesions had almost disappeared. (E) The visual field of the right eye showed a superior altitudinal defect one day after TFCA. (F) Seven days after TFCA, minimal change in the superior defect in the visual field of the right eye. (G) Thirty days after TFCA, superior nasal field defect remained, with minimal improvement. (H) Inferior neuroretinal rim thinning and retinal nerve fiber layer (RNFL) defect in the inferior temporal quadrant were detected on spectral domain-optical coherence tomography

Findings

Discussion

Conclusions