Cortical blindness caused by acute general cerebral swelling

Area of Science:

• Neuroscience
• Neurology
• Pediatric Neurology

Background:

• Acute general cerebral swelling can result from severe head trauma.
• Transtentorial herniation is a critical complication of increased intracranial pressure.
• Cortical blindness and alexia are potential neurological deficits following brain injury.

Observation:

• A 7-year-old girl sustained a traffic accident leading to acute cerebral swelling.
• Initial computed tomography (CT) scans showed slitlike ventricles and narrowed cisterns, indicative of swelling.
• The patient experienced two episodes of transtentorial herniation with cistern obliteration.

Findings:

• Post-recovery, the patient presented with cortical blindness, later evolving into pure alexia without agraphia.
• Visual evoked potentials (VEPs) normalized over time but showed persistent left occipital inactivity.
• This suggests residual damage in the left occipital lobe despite overall visual pathway recovery.

Implications:

• This case highlights the complex visual and linguistic deficits that can arise from severe pediatric head trauma.
• Persistent occipital lobe dysfunction may underlie specific neurological impairments like pure alexia.
• Long-term neurophysiological monitoring (VEPs) is crucial for assessing recovery and identifying residual deficits after traumatic brain injury.