2026 American Academy of Neurology Abstract Website

Objective:

Transient cortical blindness (TCB) is a rare complication of cerebral angiography with an incidence between 0.24% and 1%. TCB occurs due to hypothesized visual cortex neurotoxicity from contrast exposure, particularly with posterior circulation injections and higher contrast doses. We present a case of TCB following diagnostic cerebral angiography that highlights the importance of recognizing this diagnosis of exclusion.

Background:

N/A

Design/Methods:

This is a case report of a 53-year-old female with history of pituitary adenoma who developed acute vision loss following digital subtraction angiography (DSA) performed for workup of a 2 cm right thalamic hemorrhage discovered on surveillance MRI.

Results:

The patient underwent DSA with injection of the right carotid and vertebral arteries, which revealed no vascular abnormalities. Two hours post-procedure, she developed acute bitemporal blurred vision with bifrontal headache and nausea, progressing to complete blindness over 90 minutes. Neurological examination revealed equal and reactive pupils, intact extraocular movements, absent blink to threat bilaterally, negative optokinetic response, and absent light and motion perception. Repeat CTA and MRI were unchanged from pre-procedure imaging. EEG showed no epileptiform activity. The temporal relationship to contrast exposure and stable neuroimaging excluded alternative diagnoses including pituitary apoplexy, acute stroke, posterior reversible encephalopathy syndrome, and seizure-related visual phenomena. Her visual symptoms completely resolved overnight with full vision restoration within 18 hours. Ophthalmological evaluation was normal, and she experienced no residual deficits.

Conclusions:

This case emphasizes that TCB should be considered in patients developing acute visual symptoms after contrast-enhanced procedures. Though typically self-limited and reversible, early recognition prevents unnecessary interventions and reduces patient anxiety. Management is supportive, as demonstrated in this case. Judicious contrast use, particularly with posterior circulation injections, may help prevent TCB.