Cortical blindness induced by hepatic encephalopathy: case report and review of published case reports

Hepatic cortical blindness

Hepatic cortical blindness is an unusual clinical complication of hepatic encephalopathy, and its epidemiology has not been studied in detail. Herein, we present a case report of a 37-year-old male with liver cirrhosis and immunoglobulin A nephropathy who noted visual impairment after eating high-protein food. In addition to the case report, all previously documented cases of hepatic cortical blindness occurring across the globe published from inception until August 2019 were reviewed. The incidence of hepatic cortical blindness is low, and diagnoses are easily missed. The diagnosis of hepatic cortical blindness is dependent on symptoms, and patients may experience several attacks of vision loss. Most patients experience complete blindness, but vision loss recovers within 10 min to one month. Early detection and therapy for hepatic encephalopathy may improve patient outcome.

Transient cortical blindness secondary to hepatic encephalopathy in a pediatric patient: A case report and literature review

Cortical blindness, also known as cerebral visual impairment, may occur in pediatric patients. Hepatic encephalopathy is a rare cause of cortical blindness in children. This report describes a girl with underlying type 1 autoimmune hepatitis, who complained of sudden-onset, painless visual loss in both eyes, which was associated with generalized headache and altered mental status. She was treated with intravenous antibiotics and syrup lactulose. The patient regained full visual recovery after 1 week. Prompt diagnosis and treatment are mandatory in such uncommon instances.

The potential risk factors of cortical visual impairment following cerebral angiography: a retrospective study

Background

Cortical visual impairment is an uncommon complication after cerebral angiography with an incidence of 0.3%-1.0%. Here we would like to investigate and discuss the potential risk factors of cortical visual impairment after cerebral angiography.

Methods

Based on the presence of post-operative cortical visual impairment, 4,528 patients who received cerebral angiography were split into two groups. The relevant risk factors were compared and analyzed between the groups.

Results

In the patient cohort, 11 cases exhibited post-operative cortical visual impairment (0.24%). In particular, seven patients presented with blurred vision and four presented with binocular blindness. Visual sensation of these patients recovered after the treatment. Our univariate analysis revealed that differences in age, weight, sex ratios, proportions of patients with hypertension, diabetes and hyperlipemia, and operation time were not statistically significant between the two groups (P>0.05). The multivariate analysis indicated that the dosage of contrast medium was the independent risk factor for post-operative cortical visual impairment.

Conclusion

Clinically, cortical visual impairment following cerebral angiography typically presented as blurred vision or complete blindness. We have identified the dosage of contrast medium as the most critical independent risk factor based on our study. Preventive strategies need to be implemented to avoid post-operative cortical visual impairment in this regard.