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Related Experiment Videos

Cortical blindness following aortic arch surgery.

Y Suzuki1, M Kiyosawa, M Mochizuki

  • 1Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan.

Japanese Journal of Ophthalmology
|October 5, 2001
PubMed
Summary

A patient with Marfan syndrome developed cortical blindness after aortic arch surgery. Positron emission tomography (PET) revealed significant occipital cortex hypometabolism, aiding diagnosis when MRI was inconclusive.

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Medical Imaging

Background:

  • Marfan syndrome is a genetic disorder affecting connective tissue, increasing the risk of aortic dissection and requiring complex surgical interventions.
  • Aortic arch surgery, particularly with circulatory arrest, carries risks of neurological complications.
  • Cortical blindness is a rare but severe visual impairment resulting from damage to the occipital cortex.

Observation:

  • A 31-year-old male with Marfan syndrome experienced acute aortic dissection necessitating aortic arch surgery with planned circulatory arrest.
  • Postoperatively, the patient reported significant vision loss, despite normal pupillary reflexes and funduscopic examination.
  • Initial neurological assessments were inconclusive in determining the cause of visual impairment.

Findings:

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  • Magnetic Resonance Imaging (MRI) performed 2 years and 9 months post-surgery showed cortical atrophy in the occipital cortex.
  • Positron Emission Tomography (PET) with fluorodeoxyglucose (FDG) revealed profound hypometabolism in the occipital cortex.
  • These findings suggest cortical laminar necrosis likely occurred during the period of circulatory arrest.

Implications:

  • PET imaging can be crucial for diagnosing cortical blindness, especially when MRI findings are subtle or delayed.
  • This case highlights the potential for profound visual deficits following circulatory arrest in aortic arch surgery.
  • Understanding these risks is vital for patient counseling and surgical planning in complex cardiovascular procedures.