Transient Cortical Blindness After Coronary Angiography, Bypass Graft Angiography, and Coronary Angioplasty

Transient cortical blindness after coronary angiography has long been reported in the literature; however, this condition remains rare until today. We report a case of transient cortical blindness after coronary angiography, bypass graft angiography, and coronary angioplasty, which was deemed to be secondary to contrast agent. A 60-year-old man who underwent prior coronary artery bypass grafting (CABG) started to experience recurrence of exertional and resting chest pain one year after CABG. In addition to coronary artery disease, he has underlying type 2 diabetes mellitus, hypertension, and dyslipidemia. Due to technical reasons, he was unable to undergo a computed tomography (CT) angiography of the coronary arteries and bypass grafts. Invasive coronary and bypass graft angiography were done, followed by stenting of the left circumflex artery. Thirty minutes after completion of the procedure, the patient had bilateral blurring of vision, which worsened drastically to only being able to perceive light bilaterally. The patient otherwise did not have any other neurological deficits. Binocular indirect ophthalmoscopy revealed no significant abnormalities apart from mild non-proliferative diabetic retinopathy of the left eye. A non-contrasted CT scan of the brain revealed acute subarachnoid bleed in both occipital lobes, but a subsequent magnetic resonance imaging scan of the brain revealed no evidence of intracranial bleed. The patient's vision gradually improved eight hours after the index event, and his vision completely normalized 12 hours later. The patient was discharged well two days later, and at one-month, three-month, and six-month follow-up, the patient remained angina-free, and his vision had remained stable bilaterally.