Unilateral morbus Purtscher with poor visual outcome

Two cases are presented, one with a pure cranial compression injury, the other mainly with chest trauma. Both patients noted immediate unilateral blindness. Vision did not improve in either within four months. Fluorescein angiography was performed and showed arteriolar as well as venous damage, with occlusion of arterioles and venules. As the impact in morbus Purtscher is usually very brief, reflux cannot explain the fundus changes. More likely a pressure wave is the cause of vessel damage with subsequent infiltration of blood, or plasma, into the wall of the vessel and obliteration of the lumen; it is also a cause of rupture of capillaries and hemorrhage. In traumatic asphyxia, on the contrary, a sustained force leads to reflux of blood and massive congestion with subsequent vessel damage and diapedesis. The prognosis in morbus Purtscher is often poor.