Cortical blindness as a complication of hemodialysis

Cortical Blindness due to Bilateral Occipital Infarcts in a Renal Failure Patient with Prostate Cancer: A Rare Complication of Hemodialysis

Loss of vision is a rare complication seen in hemodialysis patients. It is thought to develop because of the hypotension that can be observed during dialysis. This paper involves a patient with acute loss of vision during hemodialysis due to bilateral occipital infarcts.

Transient cortical blindness after resuscitation in a child having central venous catheterization under general anesthesia

We describe a case of chronic renal failure developing life-threatening cardiovascular collapse during the insertion of central venous catheter for hemodialysis under general anesthesia in a 7-year-old boy. With timely resuscitation, he regained his vital signs within 20 min. However, after admission to the pediatric intensive care unit, visual impairment and four limb weakness were detected on the first postoperative day. Fortunately, symptoms resolved completely with close observation, psychological support and conservative management within 72 h without sequelae.

Transient visual loss may anticipate occipital infarction from hemodialysis

BACKGROUND

The aim of this study was to report on a patient who had occipital infarction from intradialytic hypotension and review the literature on hemodialysis and visual loss.

METHODS

Neuro-ophthalmologic examination and magnetic resonance imaging (MRI) of the brain were conducted.

RESULTS

A 61-year-old woman had acute onset of a right homonymous superior quadrantic visual field defect during dialysis after several episodes of transient visual loss associated with symptomatic intradialytic hypotension. MRI showed acute infarction in the left occipital lobe.

CONCLUSION

Visual loss is an uncommon complication of hemodialysis. The mechanism usually is related to hypotension and is usually from anterior ischemic optic neuropathy. Although cortical blindness secondary to stroke has been reported as a complication after hemodialysis, we were unable to find another report of visual loss secondary to stroke attributed to intradialytic hypotension with preceding episodes of transient visual loss. Transient visual loss may be a risk factor for stroke during hemodialysis.

Cortical visual impairment in children

Cortical visual impairment (CVI) in children is most commonly caused by peri- or post-natal hypoxia-ischemia, but may also occur following other insults, e.g., trauma, epilepsy, infections, drugs or poisons, and certain neurologic diseases. The disorder differs considerably in etiology, physical findings, and, perhaps, prognosis, from the cortical blindness seen in adults. The same event that causes CVI by damaging the geniculate and/or extrageniculate visual pathways may also damage other areas of the brain, or the retina, optic nerves, or chiasm. Thus, children with CVI often have other neurological problems. Diagnosis may require the participation of a multidisciplinary team and the use of special visual testing techniques. Due to the uncertainty concerning the prognosis in CVI, clinicians should remain optimistic about the child's potential for some vision recovery.

Flash and pattern-reversal visual evoked potential abnormalities in infants and children with cerebral blindness

Visual evoked potentials (VEPs) were recorded of 60 infants and children with cerebral blindness, aged between six weeks and 10 years, and compared with age-matched normative data. Every patient had abnormal VEPs. 18 had absent flash and pattern VEPs and 13 had atypical or atypical and asymmetrical flash and pattern VEPs. Of the remaining 29, most had greater abnormality of pattern than of flash VEPs and greater abnormalities over parietal and temporal than occipital areas. Eight patients had normal occipital responses to flash and five others had delayed responses with normal morphology. One had normal occipital responses to pattern stimuli. All of these had abnormal late occipital responses or abnormal responses over the parietal and temporal areas. It is recommended that visual assessments using VEPs employ both flash and pattern stimuli, that pre-occipital as well as occipital recordings be made and that tracings be compared with age-specific normative data.

Cortical blindness in children: a study of etiology and prognosis

Thirty-four children (20 boys, 14 girls) with congenital and acquired cortical blindness were analyzed for visual outcome in relation to etiology, visual evoked potentials, electroencephalography, and cranial computed tomography. All 7 children with congenital cortical blindness remained blind on subsequent examination. Of the 27 children with acquired blindness, 16 (59%) had poor visual outcome. Poor visual outcome occurred in those with cardiac arrest, hypoxia, status epilepticus, intracranial hemorrhage, cerebral thrombosis, and head trauma. Good visual outcome occurred in children with hypotensive episodes after cardiac surgery. Of the 12 children with recovery of vision, the interval from acute loss of vision to partial or total recovery was 2 weeks to 5 months. Seven children had complete recovery of vision with no residual visual field defect. The majority of children (87%) had focal or multifocal spike-and-waves and slow sharp-wave discharges on electroencephalography. None had photic recruitment response or occipital spike-and-wave discharges. Flash visual evoked potential studies performed during acute episodes of cortical blindness documented 11 with absent response, 10 with bilateral increases in latency, and 6 with normal responses. There was no correlation between normal visual evoked potentials and a good visual outcome. Only 2 of 6 children with normal responses had normal vision. Abnormal or absent responses are more predictive of a poor recovery of vision because only 3 of 21 (14%) had normal vision on subsequent examination. Abnormal electroencephalographic findings with focal or multifocal spike-and-wave discharges or cerebral atrophy on cranial computed tomography are also poor prognostic signs.

Transient acute cortical blindness associated with hypoglycemia

A 7-year-old boy with glycogen storage disease type III developed transient acute cortical blindness associated with hypoglycemia on two separate occasions; the patient also demonstrated transient high-voltage slowing on the electroencephalogram over both occipital areas. This patient is the second examined in our pediatric department during a 5 year period with acute cortical blindness associated with hypoglycemia.

Cortical blindness after cerebral angiography. Case report

A case of cortical blindness after cerebral angiography is presented. Serial computerized tomography scans of the brain revealed persistence of contrast medium in occipital visual areas as well as areas that may have been associated with "focal seizures" that occurred after angiography. This case supports the concept that cortical blindness may be secondary to the direct effect of contrast medium on the brain. The persistence of contrast material was in part due to decreased renal function.

Transient cortical blindness secondary to vincristine therapy in childhood malignancies

Three children with malignancies developed severe neurotoxicity, including transient cortical blindness, following chemotherapy regimens. The only drug in common was vincristine sulfate. The clinical courses of these patient are described. All have completely recovered, although one child who was rechallenged with vincristine had a cardiorespiratory arrest, increasing neurotoxicity, and recurrence of blindness. Transient cortical blindness has not previously been attributed to vincristine sulfate therapy, but must be considered as a possible complication of treatment with this agent.