Transient Cortical Blindness: A Rare Sequelae Following Endovascular Embolization of a Basilar Tip Aneurysm

TL;DR

A 60-year-old woman experienced temporary vision loss after a brain aneurysm treatment, highlighting a rare complication called transient cortical blindness.

Contribution

This case report documents transient cortical blindness as a rare sequelae following endovascular embolization of a basilar tip aneurysm.

Findings

The patient developed bilateral vision loss post-procedure but fully recovered within 48 hours.

Transient cortical blindness was identified as the most likely cause after ruling out other conditions like PRES.

Abstract

A 60-year-old woman with hypertension and a family history of aneurysms was found to have an incidental basilar tip aneurysm following a fall at Alicante airport. She had no history of polycystic kidney disease and was a non-smoker. The aneurysm measuring 1.2 cm was discovered following imaging after the head injury. The patient was counselled about treatment options, including endovascular embolization, which she opted for after understanding the cumulative risk of rupture. The procedure was performed via right common femoral artery (CFA) and left superficial femoral (SF) access under ultrasound guidance. Stents (2.25mm Leo Baby, Debene S.A., Buenos Aires, Argentina) were placed in both posterior cerebral arteries (PCAs), followed by subarachnoid (SA) coiling of the aneurysm. Post-procedure angiography confirmed no residual aneurysm filling, patent branches, and no thrombus formation.

Postoperatively, the patient developed bilateral vision loss and intermittent confusion. Neurological examination, including cranial nerve and ophthalmology assessment, was unremarkable except for anterograde amnesia. Arterial blood gas (ABG) analysis ruled out metabolic causes, and inflammatory markers and septic screening were unremarkable. Repeat MRI with diffusion-weighted imaging (DWI) sequences showed no acute infarction. Supportive management, including intravenous fluids, antithrombotic therapy, and symptomatic relief, was initiated. The patient’s vision improved from perception of light (PL) to hand motion (HM) bilaterally and fully recovered within 48 hours.

This case highlights transient cortical blindness as a possible complication following cerebral angiography. The primary differential was posterior reversible encephalopathy syndrome (PRES), but the absence of other symptoms such as headache, aphasia, facial numbness, seizures, ataxia, or visual hallucinations made transient cortical blindness the more likely etiology.

Figures