Recurrent Transient Cortical Blindness After Bilateral Carotid Artery Stenting

Transient cortical blindness is a rare manifestation of contrast-induced encephalopathy and an important stroke mimic after angiographic procedures.

An 84-year-old man developed acute bilateral cortical blindness with encephalopathy immediately after right internal carotid artery stenting. Neuroimaging was normal, and symptoms resolved completely within 20 hours. Four years later, he underwent left internal carotid artery stenting with minimized contrast volume and prophylactic corticosteroids and antihistamines, yet experienced an identical episode with full recovery. Both events were temporally related to contrast exposure and lacked imaging evidence of infarction or hyperperfusion injury.

This case highlights persistent susceptibility to contrast-induced neurotoxicity, distinguishes it from ischemic stroke and hyperperfusion syndromes, and expands the literature by demonstrating recurrence after sequential bilateral carotid artery stenting.

Recurrent transient cortical blindness can occur years apart after carotid artery stenting and should be recognized promptly to avoid unnecessary interventions.