[Delayed postanoxic encephalopathy with visual field disturbance after strangulation: a case report]

We report the case of a 30-year-old woman with delayed postanoxic encephalopathy and visual field disturbance caused by strangulation. Although she was normal up to the sixth day after strangulation, she developed quadrantic hemianopia on the seventh day. The results of magnetic resonance imaging (MRI) showed high-intensity T(2) and fluid-attenuated inversion recovery (FLAIR) signals in the bilateral striatum; on the basis of these findings, she was diagnosed with delayed postanoxic encephalopathy. Associated with quadrantic hemianopia, an area with low-intensity FLAIR signals was noted in the subcortical region of the right occipital cortex. Single-photon emission computed tomography (SPECT) revealed decreased blood flow in the right occipital lobe and striatum. By day 41 after strangulation, the low-intensity area in the subcortical region of the right occipital cortex disappeared, and high-intensity FLAIR signals were observed in the right occipital cortex. The quadrantic hemianopia and occipital lesion that were revealed by MRI regressed 4 months later. Respiratory dysfunction or circulatory dysfunction causes ischemia of the entire brain; however, strangulation does not lead to disturbances in the blood flow in the regions supplied by the vertebrobasilar artery. However, in the case of the present patient, a lesion was noted in the occipital lobe after strangulation. It has been reported that the autonomic control in the vertebrobasilar artery is weak, and the control of blood pressure in this artery is limited. In the case of this patient, not only the ischemia resulting from the stricture of the artery and the trachea, but also congestion resulting from disturbances in the venous blood flow might be associated with the brain damage and might have thus led to the development of the occipital lesion.