Delayed Cortical Blindness after Cardiac Arrest (P6.267)

Introduction: Cortical blindness is defined as visual loss secondary to damage to the geniculocalcarine visual pathways. In adults, it is most commonly caused by cerebrovascular disease however cardiac surgery and cerebral angiography are also major causes of this disease. The first reported case of cortical blindness following cardiopulmonary resuscitation was in 1949. We describe a case of delayed cortical blindness six days after return of spontaneous circulation from a cardiopulmonary arrest. Case Presentation: A 50 year old female presented to the emergency room with a one day history of painless binocular vision loss. Exam revealed markedly decreased visual acuity bilaterally however color recognition, motion perception, and visual fields were preserved. Pupils were reactive to light and accommodation. The patient presented six days prior to her visual symptoms in cardiac arrest. Patient’s husband performed cardiopulmonary resuscitative measures for approximately five minutes. When emergency medicine personnel arrived the patient was found to have pulseless electrical activity. The patient had return of spontaneous circulation after two rounds of CPR. Subsequently, the patient was discharged five days later without any clinical complications from her arrest. On the sixth day after cardiopulmonary arrest the patient had the aforementioned symptoms of decreased visual acuity and was readmitted to the hospital. MRI of the brain performed eight days after her arrest revealed scattered areas of diffusion restriction and T2 hyperintensity within the occipital lobes bilaterally. After 6 months and visual rehab, the patient reported significant improvement in visual acuity. Cortical laminar necrosis, mostly affecting layers 3 and 4 has been described after anoxic brain injury. Complexity of visual analysis of an image projected to different parts of the visual cortex may explain the severe impairment of visual acuity in our patient with preservation of color and motion perception on presentation. Disclosure: Dr. Lugo has nothing to disclose. Dr. Alwaki has nothing to disclose. Dr. Goshgarian has nothing to disclose. Dr. Belsky has nothing to disclose. Dr. Mitsias has nothing to disclose.