Transient post-traumatic cortical blindness: brief v prolonged syndromes in childhood

Six children who sustained head trauma of varying degrees experienced self-limited cortical blindness--complete bilateral visual loss associated with normal pupillary responses to light. In five cases associated with relatively minor head trauma, full visual function returned within 24 hours. In the other case, associated with parietal and occipital contusions, the period of complete blindness was prolonged, lasting 1 week, followed by a striking recovery over an additional week. A bilateral inferior altitudinal visual field deficit has persisted over 6 years, with emergence of a complicated migraine syndrome. Sequential computed tomographic (CT) scans over a 4-year period demonstrate bioccipital and right parietal injury, correlating clinical and anatomic findings. This case is the first description of prolonged transient post-traumatic cortical blindness in a child with CT correlation. It underscores the clinical, radiographic, and pathophysiologic differences between syndromes of brief and prolonged transient post-traumatic cortical blindness in childhood.