Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 406-411
DOI: 10.4103/ajns.AJNS_473_20
Case Report

Cortical blindness after cervical spine surgery in supine position – A rare case report and review of the literature

Raghav Mulukutla
Department of Spine Services, Udai Omni Hospital, Hyderabad, Telangana
,
Phani Yelamarthy
1   Consultant Spine Surgeon, Department of Spine Surgery, Udai Omni Hospital, Hyderabad, Telangana
,
RamMohan Vadapalli
2   Consultant Radiologist, Vijaya Diagnostics, Hyderabad
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

We report the first case of perioperative visual loss due to cortical blindness after supine cervical spine surgery. A 46-year-old female presented with severe right-sided brachialgia of 1½ years' duration. Her magnetic resonance imaging (MRI) (cervical spine) showed severe right foraminal stenosis at C5–6. She underwent C5–6 anterior cervical discectomy and fusion. Nine hours after surgery, during a routine postoperative round, the patient complained of complete bilateral visual loss. The fundus examination and pupillary light reflex were normal. MRI of the brain showed the posterior cerebral artery infarct with hypoplasia of the left vertebral artery. She was transferred to the neurointensive care unit where antiplatelet treatment was started along with heparin. Her vision slowly began to improve, and at the end of 1 year, she had a reasonable visual acuity in both eyes. It is now standard practice in our institution to check patients' vision immediately after surgery.

Key-words:

Cervical - cortical blindness - infarct - perioperative visual loss - spine surgery - supine

Financial support and sponsorship

Nil.




Publication History

Received: 17 October 2020

Accepted: 13 March 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Baig MN, Lubow M, Immesoete P, Bergese SD, Hamdy EA, Mendel E. Vision loss after spine surgery: Review of the literature and recommendations. Neurosurg Focus 2007;23:E15.
  • 2 Epstein NE. Perioperative visual loss following prone spinal surgery: A review. Surg Neurol Int 2016;7:S347-60.
  • 3 Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol 2010;4:531-46.
  • 4 Agarwal N, Hansberry DR, Goldstein IM. Cortical blindness following posterior lumbar decompression and fusion. J Clin Neurosci 2014;21:155-9.
  • 5 Vaiano AS, Valente C, De Benedetti G, Caramello G. Transient cortical blindness after intradiscal oxygen-ozone therapy. Indian J Ophthalmol 2016;64:944-6.
  • 6 Nathan ST, Jain V, Lykissas MG, Crawford AH, West CE. Transient cortical blindness as a complication of posterior spinal surgery in a pediatric patient. J Pediatr Orthop B 2013;22:416-9.
  • 7 Goni V, Tripathy SK, Goyal T, Tamuk T, Panda BB, Bk S. Cortical blindness following spinal surgery: Very rare cause of perioperative vision loss. Asian Spine J 2012;6:287-90.
  • 8 Huber JF, Grob D. Bilateral cortical blindness after lumbar spine surgery. A case report. Spine (Phila Pa 1976) 1998;23:1807-9.
  • 9 Ibrahim TF, Sweis RT, Nockels RP. Reversible postoperative blindness caused by bilateral status epilepticus amauroticus following thoracolumbar deformity correction: Case report. J Neurosurg Spine 2017;27:63-7.
  • 10 Mione G, Pische G, Wolff V, Tonnelet R, Humbertjean L, Richard S. Perioperative bioccipital watershed strokes in bilateral fetal posterior cerebral arteries during spinal surgery. World Neurosurg 2016;85:367.e17-21.
  • 11 Vakharia K, Siasios I, Dimopoulos VG, Pollina J. Posterior reversible encephalopathy syndrome resolving within 48 hours in a normotensive patient who underwent thoracic spine surgery. J Clin Med Res 2016;8:263-6.
  • 12 De la Garza-Ramos R, Samdani AF, Sponseller PD, Ain MC, Miller NR, Shaffrey CI, et al. Visual loss after corrective surgery for pediatric scoliosis: Incidence and risk factors from a nationwide database. Spine J 2016;16:516-22.
  • 13 Stevens WR, Glazer PA, Kelley SD, Lietman TM, Bradford DS. Ophthalmic complications after spinal surgery. Spine (Phila Pa 1976) 1997;22:1319-24.
  • 14 Williams EL. Postoperative blindness. Anesthesiol Clin North Am 2002;20:605-22.
  • 15 Bijker JB, Gelb AW. Review article: The role of hypotension in perioperative stroke. Can J Anaesth 2013;60:159-67.
  • 16 Dutton RP. Controlled hypotension for spinal surgery. Eur Spine J 2004;13 Suppl 1:S66-71.
  • 17 Iqbal S. Vertebrobasilar variants and their basic clinical implications. Int J Med Res Heal Sci 2013;2:799-808.
  • 18 Park JH, Kim JM, Roh JK. Hypoplastic vertebral artery: Frequency and associations with ischaemic stroke territory. J Neurol Neurosurg Psychiatry 2007;78:954-8.