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Delayed-onset hypoxic cortical blindness: coming back from the abyss.

Alexandre Majoulet¹, Isabelle Audo^2,3, Cécile Goujard^4,5

¹Department of Ophthalmology Assistance Publique - Hôpitaux de Paris, Service d'ophtalmologie, Hôpital Bicêtre, 78, Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.

Documenta Ophthalmologica. Advances in Ophthalmology

|January 3, 2022

Summary

Delayed-onset hypoxic cortical blindness, a rare condition after drowning, can cause severe vision loss but may dramatically improve with visual rehabilitation. This case highlights the potential for recovery even after significant visual impairment.

Keywords:

Apnea Cortical blindness Visual evoked potential Visual rehabilitation

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Area of Science:

Neuro-ophthalmology
Neurology
Emergency Medicine

Background:

Delayed-onset hypoxic cortical blindness is a rare complication following hypoxic events.
This condition typically manifests days after the initial hypoxic insult.

Observation:

A young male presented with severe vision loss (hand motion) 12 days after drowning resuscitation.
Ophthalmological and neurological examinations revealed bilateral centrocecal scotoma and abnormal visual evoked potentials.
Brain MRI confirmed hypoxic cortical blindness with bilateral occipital laminar necrosis.

Findings:

Despite initial severe visual acuity reduction, the patient showed remarkable visual recovery with visual rehabilitation.
Best corrected visual acuity improved to 20/32, enabling reading within two weeks of rehabilitation.
Rehabilitation led to a reduction in the size of the visual field defects.

Implications:

This case underscores the potential for significant visual recovery in delayed-onset hypoxic cortical blindness.
Early and targeted visual rehabilitation may dramatically enhance outcomes.
Clinicians should consider this diagnosis in patients with unexplained vision loss post-hypoxia.