Went blind after angioplasty?

Question

My mother had an angioplasty done yesterday with stents. When she came out, she was saying she couldnt see. It;s been almost 24 hours and she still can not see. She is only 46 and this should not be happening =( She has strong grips, and nothing changed on her monitors. Also they did a catscan and nothing.

Has anyone been in this situation and had their vision came back shortley? Or does anyone know if it can come back?

Answer 1

Transient cortical blindness related to coronary angiography was first reported in 1970.1 Since then there have been fewer than two dozen cases recorded, some of which include angiography of coronary bypass grafts.2-5 This is a rare neurological complication given the widespread and frequent use of such investigations worldwide.

The incidence of cerebrovascular complications in diagnostic cardiac catheterisations and coronary angiography is low. The National Institutes of Health in America reported a rate of 0.03%,6 and the British Cardiac Society report from 34 041 patients gave an incidence of 0.06%.7 This included cerebrovascular accidents, transient ischaemic attacks and amaurosis fugax. Neither study described transient cortical blindness. Usually neuro-ophthalmologic complications of cardiac catheterisation relate to embolic phenomena or migraine.

Cortical blindness is better recognised as a complication of cerebral and vertebral angiography, with an incidence of 0.3%–1.0%,8 but as high as 4% when hyperosmolar iodinated contrast agents are used.3 However, it can occur with newer low-osmolar and non-ionic radiographic contrast media, and this potential complication is indicated in the product information.

Review of clinical information available from English language reports of transient cortical blindness after coronary angiography showed 17 cases.2-5,8-12 Thirteen of these involved men, and only four involved women, but this reflects the greater number of men who have coronary artery investigations. The average age of the patients was 58 years, and more than half (10 patients) had known systemic hypertension. Eleven (65%) had angiography of internal mammary artery grafts. Another five had additional aortography or coronary angioplasty. The volume of contrast dye used ranged from 80–400 mL. The time taken to recover normal vision varied from 15 minutes to three weeks, with an average of three days.

Selective vertebral angiography carries the highest risk of neurological complication.13-15 As the internal mammary artery used for coronary grafting is adjacent to the origin of the vertebral artery, it is likely that a direct injection into the vertebral artery occurs. The cerebral reaction is not patient-specific, as later rechallenge with contrast medium has produced no recurrence.3 Minimising the amount of dye used is also advisable.3
Pathophysiology

The mechanism of cerebral injury remains speculative. It is thought that contrast agents disrupt the blood–brain barrier in the occipital lobes and exert a neuronal toxic effect.13

The posterior cerebral circulation is known to be more susceptible to such injury and this may relate to differences in sympathetic innervation.14 There may be a relationship to hypertensive encephalopathy, a clinical syndrome which can include visual disturbances. Imaging in hypertensive encephalopathy, including eclampsia, has shown bilateral abnormalities in the occipital lobes, involving the subcortical white matter and often extending to the cortical surface.16 Reversible oedema, localised mainly to the occipital lobes, is a prominent feature.

Our patient was known to be taking drugs for chronic hypertension and had a documented acute blood pressure rise during the procedure. More than half the patients in previous reports had chronic hypertension, although the details of pressure changes during angiography have not usually been reported. Hypertensive encephalopathy is thought to result from sudden elevation of systemic blood pressure exceeding the auto-regulatory capacity of the cerebral vessels, producing regions of vasodilatation and vasoconstriction with a breakdown of the blood–brain barrier and focal transudation of fluid.16

These mechanisms seem possible in our patient, and they were supported by the results of imaging studies. There were bilateral occipital lobe changes when she had clinical cortical blindness (Box 1), representing oedema and passage of contrast across the blood–brain barrier. Cortical blindness is synonymous with bilateral homonymous hemianopia from involvement of the occipital cortex.1 When our patient was recovering and exhibiting right homonymous hemianopia, there were MRI changes in the left occipital gyrus, and differences in the calibre of the vessels on the two sides (Box 2).
Prognosis

It is devastating for the patient, the family and the person carrying out the procedure when cortical blindness complicates coronary angiography. Cerebral embolism and haemorrhage have to be excluded by CT scan or MRI studies. Fortunately, the condition is usually transient.

Lessons from practice

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Transient cortical blindness is a rare but alarming complication of coronary angiography.
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It has to be differentiated from an embolic problem. Computed tomography or magnetic resonance imaging is necessary.
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Oedema secondary to disturbance of autoregulation of the posterior cerebral vessels is a possible mechanism.
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Vision is usually recovered fully within a few days.

You can visit the link given below for other details:





http://www.mja.com.au/public/issues/177_01_010702/lim10473_fm.html

Answer 2

Do you speak medicalese?

Your question piqued my curiosity, so I did a little internet search. I do speak medicalese enough to realize that there are a lot of reports of "transient cortical blindness" following angiography. Not angioplasty specifically, but it may not make a lot of difference, because they blame the contrast media, and they have to use contrast for angioplasty, too.

Just in case you can deal with medicalese, I am including a link to one of the few medical journal articles that you can get for free on the net in English. It has a bibliography that refers to other cases.

They keep using the word "transient." If you are looking for any information at all, I hope the word "transient" helps you somewhat.

Answer 3

Where was the angioplasty done? If it was coronary heart stenting them that seems quite odd.

This is a case for Doctor House. Or some other guy with an arnchair degree that will surely answer immediately after me.

Answer 4

Just type the word"angioplasty" in the google or yahoo search engine and you will come up with loads of infor. All the plus and the minus of this surgery. Your mum is only 46 why did she have to go for this. Hope she get her sight back soon.

Answer 5

I am not familiar with blindness after angioplasty but God bless her and I hope she recovers her sight soon!

Has the doctor not said anything about it?