To identify complications like transient loss of vision post contrast procedures.

Transient cortical blindness is one of the neurotoxic effects of cerebral arteriography characterized as sudden, bilateral loss of vision with preserved pupillary reflexes. Pathophysiology involves disruption of blood brain barrier causing direct neurotoxicity specially in the posterior circulation.

66 year old female with history of left sided basal ganglia stroke with residual right sided weakness, admitted to the hospital for elective stent coil of an unruptured 8 mm basilar tip aneurysm developed a worsening frontal headache post procedure. A few hours later she had sudden onset loss of vision in both her eyes which prompted a stroke code. CT head revealed posterior fossa hypodensities while the CTA revealed left V3 non-occlusive thrombus. While reviewing the records, no hypertensive episode was noted prior to activation of the stroke code. Her home medications were reviewed and no drugs were recognized that are associated with PRES. She was transferred to NCCU for further care and started on Decadron for suspicion of Contrast induced transient cortical blindness causing vision loss. In the next 24 hours, her vision started to improve.

Transient cortical blindness post contrast is a rare complication that can occur within minutes to 12 hours, characterized by sudden onset vision loss with normal pupillary reflexes, unaltered extraocular movements, and normal fundi (1,2). Since the sympathetic innervation of posterior circulation is not as extensive, this makes the blood brain barrier in that area more breachable(3). This is a reversible condition and resolves with IV hydration and/or use of steroids.