pain-management-internal-medicine-2019-scientifictracks

4 / 15

Pain Management 2019 & Internal Medicine 2019 International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X Page 26
JOINT EVENT
7th Edition of International Conference on
Pain Management
8th Edition of International Conference on
Internal Medicine &
Patient Care
&
March 25-26, 2019
Rome, Italy
Contrast induced corticol blindness
Mayank Ohri, Parth Parikh, James Davenport and Jose Gascon
Kendall Regional Medical Center, USA
Introduction: Transient cortical blindness after contrast
induced media is an extremely rare occurrence. It has
been estimated that approximately 1% of the patients
suffer cortical blindness after undergoing a cerebral or
vertebral angiography. Based on our literature review only
18 documented cases have been reported of transient
cortical blindness secondary to coronary angiography
using modern, non-ionic, low-osmolality based contrast
agents. We present a case of an elderly man with
symptomatic bradycardia who underwent dual-chamber
permanent pacemaker implantation that had transient
contrast induced cortical blindness.
Case Report: Patient is a 77-year-old male truck
driver with a past medical history of hyperlipidemia
that presents to our hospital after a syncopal episode
that resulted in left rib pain. He reported loss of
consciousness after drinking several beers and felt as
if the room was spinning around him. He denied any
postictal confusion, loss of urinary or bowel incontinence.
CT scan of the chest was done which showed 4th and
5th rib fractures. On EKG his heart rate was 47 beats per
minute with a new onset of right bundle branch block
with no ST segment changes. His 2D echocardiogram
and troponins were within normal limits. He underwent
a tilt table study, which showed classic mixed cardio
inhibitory and vasodepressor response, with heart rate in
20’s, consistent with neurocardiogenic syncope. Based
on these findings, a dual chamber cardiac pacemaker
was implanted successfully, without any complications.
Agents that were used during the procedure included
lidocaine for local anesthesia and low osmolality, non
ionic iodine based contrast. Approximately 1 hour after
the procedure the patient started to experience blurred
vision, which soon progressed to bilateral blindness.
On examination, his fundoscopic examination was
normal and no neurological deficit was present except
for blindness. Since, he was not a candidate for an MRI;
he underwent head/neck CTA that was within normal
limits. Next day at 1:30 am the patient started to notice
improvement in his vision and by 9:00 am his vision was
restored back to normal. Based on this clinical picture it
was concluded that his transient bilateral loss of vision
was contrast induced. Patient was safely discharged
from the hospital soon after.
Conclusion: Contrast induced cortical blindness is an
extremely rare finding. This is an excellent case to inform
healthcare professionals of a potential serious side
effect from a commonly used agent. There is no specific
measure that needs to be taken for protection against this
unusual and alarming complication. Careful neurological
assessment and consultation accompanied by MRI or CT
scanning can confirm the diagnosis. When these agents
cause cortical blindness then it is anticipated and it takes
24-72 hours for resolution back to normal vision.
Biography
Dr. Mayank Ohri graduated medical school from American
University of Antigua. Currently a full time Internal Medicine
Physician at Kendall Regional Medical Center in Miami Florida.
Participated in multiple research projects including quality im-
provement, oral and poster presentations at National Internal
Medicine Conferences. He is anticipated to complete his MBA
majoring in Healthcare Administration in 2019.
Mayank Ohri et al., Int J Anesth Pain Med 2019, Volume 5
DOI: 10.21767/2471-982X-C1-005