Transient Blindness Research Articles

Prophylaxis with aspirin should be considered

EDITOR,—Helen Ward and John S Yudkin have found no evidence that thrombolysis increases the risk of haemorrhage from retinopathy.1 This will increase doctors' confidence in choosing whether to use thrombolytic drugs for myocardial infarction in patients with diabetes. But the argument that prevented use of these drugs in people at risk of vitreous haemorrhage has always been flawed. Vitreous haemorrhage usually causes transient blindness, indicating that there is proliferative retinopathy that needs treatment. Laser treatment and, if necessary, vitrectomy are extremely effective in preventing further vitreous …

陳旧性キニーネ網膜症患者の麻酔後一過性視力障害

陳旧性キニーネ網膜症患者の麻酔後一過性視力障害

Spontaneous Coronary Artery Embolus Associated With Calcific Aortic Stenosis

Calcific embolization from aortic stenosis may be more frequent than commonly appreciated. Most calcific emboli are clinically silent, although transient ischemic attacks, cerebral infarcts, blindness (from central retinal artery occlusions), and myocardial infarctions have been reported. We describe a patient with calcific bicuspid aortic stenosis who presented with transient ischemic attacks and angina secondary to a calcific embolus to the second circumflex marginal coronary artery. The calcific embolus was retrieved during aortic valve replacement surgery. A review of the literature suggests that calcific embolization from calcific aortic stenosis may occur more commonly in patients with bicuspid valves.

Transient Blindness in Pregnancy Induced Hypertension

Sudden blindness in pregnancy is a devastating experience for the patient, her family and the treating obstetrician. Four cases of cortical blindness with pregnancy induced hypertension are presented, seen at the General Hospital Kota Bharu, Kelantan, in 1990. The incidence at the GHKB was 1: 1559 (4 cases out of 6,237 deliveries) which is higher as compared to neighbouring Singapore. The pathophysiology of this condition is still not well understood, though it is hoped that newer sophisticated imaging techniques like magnetic resonance imaging (MRI), CT scan, and blood flow waveform analysis by Doppler ultrasound will throw some light on the subject. Two of our cases presented with antepartum and two with postpartum cortical blindness. Therefore, termination of pregnancy alone may not provide the solution to this therapeutic dilemma.

Post-traumatic transient cortical blindness

Five patients: three children, one adolescent, and one young adult, examined in an emergency room setting were diagnosed with post-traumatic transient cortical blindness. This syndrome is characterized by transient visual loss, normal pupillary response and normal funduscopic examination following minor head trauma. In each case, vision returned to normal within minutes to hours following injury, leaving no neurological sequelae. Headache, confusion, irritability, anxiety, nausea and vomiting were the most common related symptoms. While the mechanism responsible for the transient blindness is unknown, most authors propose an abnormal vascular response to trauma with resultant transient hypoxia and cerebral dysfunction. The similarity between the symptoms accompanying this syndrome and those seen during a classic migraine attack has led many investigators to suggest a common underlying pathophysiology. The purpose of this report is to highlight the salient clinical features and diagnostic approaches to this syndrome, thereby providing ophthalmologists and emergency room physicians a heightened awareness of this entity and the means to detect it.

Pituitary hemorrhage in hemolytic uremic syndrome

A 5-year-old girl with hemolytic uremic syndrome is reported with pituitary hemorrhage in the acute phase. Seizures, hemiplegia, and transient blindness were observed. These symptoms cannot be attributed to the pituitary hemorrhage; however, pituitary hemorrhage should be added to the list of neurologic lesions that can occur in hemolytic uremic syndrome.

Seizures and cortical dysfunction following high-dose cisplatin administration in children

Four of eight children with advanced neuroblastoma treated with a rapid delivery high dose intensity cisplatin based regimen developed acute neurological toxicity. Three had seizures and one developed transient blindness. In the absence of other causes it seems probable that high dose cisplatin (200 mg/m2) as a continuous infusion over five days followed 10 days later by 80 mg/m2 infused over 48 hours was responsible. Other risk factors included an associated deterioration in renal function and neutropenia related fever.

Endoscopic Sinus Surgery-Reply

In Reply .—Singh's communication is both interesting and timely. We are aware of several incidents in the past 5 years of transient changes in either ocular mobility or dilatation of the pupil following injection of the lateral nasal wall or middle turbinate with lidocaine (Xylocaine). We have also learned of one episode of transient blindness following injection of the middle turbinate with lidocaine. Our own experience has been limited to transient mydriasis in a patient with widely dehiscent optic nerves within the sphenoid sinus who was undergoing extensive endoscopic surgery. In all these cases, the patient made a spontaneous, complete recovery within hours of the physician noting the ophthalmologic alterations. Given the above reports, and undoubtedly many more such similar incidents, Singh's mechanisms of dilatation of the pupil without other ophthalmologic problems, are reasonable. In recent years, the mechanism of visual changes following injection of the lateral nasal wall has

Biopsy‐proven cerebral vasculitis associated with cocaine abuse

We report cerebral vasculitis in 2 cocaine users who developed symptoms (transient blindness and persistent headache) while smoking "crack," followed by progressive widespread cerebral dysfunction with focal signs over the next few weeks. One patient had smoked crack exclusively, and the other also used cocaine intravenously. Sedimentation rates were elevated and HIV titers negative. Arteriography was normal in 1 patient and in the other showed multiple large-vessel occlusions without beading. Brain biopsy showed vasculitis involving small vessels in both patients. Multinucleated cells were present in the neuropil, but there were no granulomas or evidence of infection. One patient improved significantly with corticosteroid treatment, and made a good recovery. The other died despite corticosteroid and cyclophosphamide treatment.

Transient postoperative blindness as a possible effect of glycine toxicity

This case report of transient blindness after bilateral knee arthroscopy postulates glycine toxicity as a possible cause of postoperative blindness. The orthopaedic surgeon should be aware of this dose-related effect, and should use glycine irrigant selectively and sparingly for electrosurgical applications.

Acute Rheumatologic Disorders in the Elderly

A variety of rheumatologic disorders affect the elderly. Some of these problems are seen almost exclusively in the elderly, such as temporal arteritis and pseudogout. Because of underlying chronic diseases, these patients are also at increased risk for joint infection and resultant sepsis. Evaluation of synovial fluid from the inflamed joint is important. Light microscopy evaluation with a red polarizing compensator can help diagnose crystal-mediated disease, such as gout or pseudogout. Examination of Gram stains can help diagnose infectious arthritis. Thus, appropriate processing of synovial fluid is mandatory for the diagnosis of many rheumatologic disorders that occur in the elderly. A variety of metabolic disorders are associated with pseudogout and should be searched for on laboratory evaluation. Appropriate laboratory evaluation and follow-up following the acute episode are important in the care of these patients. For example, temporal arteritis with resultant blindness is a feared disorder in the elderly. Transient blindness, headaches, jaw claudication, and an elevated Westergren sedimentation rate suggest this diagnosis. Aches and pain in the neck and shoulder area, especially in the morning, are typical of polymyalgia rheumatica. Polymyalgia rheumatica may also be a symptom of temporal arteritis.

Blindness following minor head trauma in children: A report of two cases with a review of the literature

The spectrum of closed head injury ranging from asymptomatic to lethal is well described in the literature. In a small number of cases, dramatic neurologic symptoms normally associated with cerebrovascular accident or vascular headache may arise following apparently insignificant head trauma. We report two cases of young males who developed transient blindness accompanied by significant neurologic abnormality following trivial head injuries. These phenomena are previously well documented, and it is believed that in certain individuals, minor head trauma can induce a type of migraine equivalent known as "footballer's migraine" or "posttraumatic cortical blindness." Current knowledge of these two conditions is reviewed.

Transient blindness in pregnancy induced hypertension

Transient blindness associated with pregnancy induced hypertension without neurological symptoms is a rare phenomenon. The blindness in these cases is postulated to be of “cortical blindness”. Two such cases occurring immediately after childbirth are presented. The ophthalmic manifestations of this complication of pregnancy induced hypertension and the importance of an urgent evaluation are discussed.

Ictal Cortical Blindness with Permanent Visual Loss

Cortical blindness is rarely an ictal manifestation. We report the case of a man who developed transient cortical blindness followed by permanent visual deficits during repeated partial seizures. Intermittent visual impairment began at age 14 years. After he had the first generalized seizure at age 28 years, neurologic, ophthalmologic, angiographic, and brain computed tomographic (CT) examinations were normal. Several EEGs showed almost continuous biposterior spike-waves. Over the next several years, frequent partial seizures were associated with transient visual loss and left body twitching or paresthesias. When he was 32, transient blindness occurred during several days of repeated occipital seizures. Permanent left homonymous hemianopia, right homonymous central scotoma, dyschromatopsia, and altered stereopsis followed these seizures. Brain CT demonstrated a new right occipital lesion. Partial seizures arising posteriorly may cause transient cortical blindness and result in permanent visual deficits.

Transient Blindness in Pre-Eclakpsia: Two Cases and A Review of the Literature

Two patients with severe pre-eclampsia in the third trimester of pregnancy developed sudden blindness. Physical examination and computed tomography indicated a central cause, most likely cerebral edema. Swan-Ganz catheterisation revealed a low cardiac preload and a markedly elevated afterload. Following pharmacologic reduction of the afterload the blindness disappeared completely.On the basis of the two cases presented and a review of the pertinent literature we conclude that temporary cortical blindness in patients with severe pre-eclampsia may usually be attributed to focal cerebral edema. It seems likely that a combination of high cerebral arterial pressure, leading to disruption of capillary tight junctions, with an elevated interstitial cerebral colloid osmotic pressure constitutes the main determinant of fluid leakage into cerebral tissue. Treatment should consist of gradual pharmacologic reduction of mean arterial blood pressure.

Transurethral resection of the prostate, serum glycine levels, and ocular evoked potentials.

Complications of transurethral resection of the prostate (TURP syndrome) when glycine is used as the irrigating fluid include cardiovascular and central nervous system abnormalities that occasionally include transient blindness. Serum sodium, glycine, potassium, chloride, ammonia, osmolality, carbonate, and blood urea nitrogen of 17 patients having TURP and 10 having cystoscopic examination were measured. Electroretinograms and visually evoked potentials (VEPs) were recorded in the preanesthetic preparatory area and in the recovery room immediately after surgery. Four patients reported visual aberrations coincident with increases in serum levels of glycine from a mean before surgery of 137.7 +/- 45.1 to 7,812.2 +/- 2,486.6 microM/l, mean +/- SD, after TURP. These patients also showed a reduction of serum sodium from 138 +/- 4.5 to 122 +/- 8.6 mEq/l that correlated significantly with serum levels of glycine (rho = -0.81). There were no statistically significant changes of serum ammonia and osmolality. Electroretinograms consistently demonstrated complete loss of oscillatory potentials. Thirty hertz flicker-following was also abolished. VEPs were more variably affected with prolongation of component "P100" latency found in both groups and probably resulting from sedative effects of diazepam. Patients experiencing the TURP syndrome showed abolishment of 30 Hz flicker-following in their VEPs. The elevated serum levels of glycine may contribute directly to visual aberrations resulting from glycine's role as an inhibitory transmitter in the retina.

Transient blindness associated with transurethral resection of the prostate.

Visual impairment or even transient blindness can result from transurethral resection of the prostate when glycine is used as the irrigating fluid. Electroretinograms were obtained from patients in the anesthetic preparation area and in the recovery room immediately after surgery. Four patients reported visual aberrations ranging from a "gray darkening" to "light perception only" coincident with elevated serum levels of glycine. Electroretinograms consistently demonstrated a loss of oscillatory potentials only in those patients with visual impairment. Thirty-hertz "flicker-following" was also attenuated. The excessive serum levels of glycine may contribute to visual impairment and may account for the dropout of oscillatory potentials generated by the retina due to glycine's role in the retina as an inhibitory transmitter.

Transient Blindness Associated with Pregnancy-Induced Hypertension. Case Reports

Transient Blindness Associated with Pregnancy-Induced Hypertension. Case Reports

Transient total blindness from quinine therapy

"Transient total blindness from quinine therapy." Annals of Tropical Medicine & Parasitology, 79(1), pp. 109–110

The Retreat of Multiple Sclerosis

The Retreat of Multiple Sclerosis