Cortical blindness

Gold AE, Marshall SM. Cortical blindness and cerebral infarction associated with severe hypoglycemia. Diabetes Care 1996 19(9) 1001-3. 

Odeh M, Oliven A. Hypoglycemia and bilateral cortical blindness. Diabetes Care 1996 19(3) 272-3. 

Visual hallucinations are very rare adverse effects of contrast media, with isolated reports after vertebral angiography or myelography. The mechanism of this adverse reaction could be similar to that reported in transient cortical blindness after infusion of contrast agents. However, other possibilities include a toxic effect of contrast media on the optic nerve, transient impairment of cerebral blood flow, which could be mediated through the release of the potent vasoconstrictor endothelin, or the formation of microclots. Two cases of visual hallucinations after coronary angiography have been reported (416). 

Low flow may occur secondary to systemic hypotension, as during cardiac arrest. This results in bilateral infarcts, usually in the posterior boundary zones, and causes cortical blindness, visual disorientation and agnosia, and amnesia. Alternatively, a relatively small fall in systemic blood pressure in the presence of internal carotid occlusion or stenosis may cause unilateral boundary zone infarction, usually in the anterior and subcortical regions. This causes contralateral weakness of the leg more than the arm, with sparing of the face. 

Conditional/unclassifiable cataracts, decreased accommodation, iritis, cortical blindness, peripheral VF loss, retinal findings, scleritis. 

Carboplacin Nausea and vomicing Bone marrow depression peripheral neuropathy (uncommon) hearing loss transient cortical blindness haemolytic anaemia... 

While preclinical data from CsA in neurodegenerative disorders was promising, larger studies in Parkinson s disease did not show any benefit along with side complications. Major neurological complications secondary to cyclosporine are well documented and are known to include confusion, cortical blindness, seizure, spasticity, paresis, ataxia and coma. Most previous reports attribute these to white matter CNS lesions or white/grey matter border lesions. Moreover, several publications appeared recently refuted neuroprotective properties of CsA and similar compounds (immu-nophilin ligands). 

Neurological adverse effects of ciclosporin have been reported in up to 39% of all transplant patients. Most are mild. The most frequent is a fine tremor, the mechanism of which is not known. From many case reports or studies in transplant patients, the pattern of ciclosporin neurotoxicity ranges from common and mild to moderate symptoms, such as headaches, tremors, paresthesia, restlessness, mood changes, sleep disturbances, confusion, agitation, and visual hallucinations, to rare but severe or hfe-threatening disorders, including acute psychotic episodes, cerebellar disorders, cortical blindness (permanent in one report), spasticity or paralysis of the limbs, catatonia, speech disorders or mutism, chorea, seizures, leukoencephalopathy, and coma (SED-13,1124) (SEDA-16, 516) (SEDA-17, 520) (SEDA-20, 343) (SEDA-21, 383) (17-19). 

Controversial reports of ocular symptoms have been published in patients taking oral ciclosporin, with ptosis and diplopia attributed to unilateral or bilateral sixth nerve palsies in four patients (who had also taken ganciclovir), and nystagmus in one patient (SEDA-21, 383). Peripheral optic neuropathy, with visual loss, nystagmus, and ophthalmoplegia, has also been reported (38). Acute cerebral cortical blindness complicating ciclosporin therapy in a 5-year-old girl (39) and transient cortical blindness and occipital seizures with visual impairment (40,41) have also been reported in association with ciclosporin. 

Cisplatin Peripheral neuropathy, deafness, cerebral cortical blindness, seizures... 

Transient cortical blindness, with severe headache and hallucinations, has been associated with the intravenous injection of methylergometrine 0.2 mg in a postpartum patient reference. 

There is no clear evidence of specific central nervous system adverse effects due to G-CSF. In one patient, neurological symptoms, such as blurred vision, weakness, and headache, were attributed to G-CSF-induced extreme hyperleukocytosis with subsequent hyperviscosity (SEDA-21, 377). Encephalopathy, cortical blindness and seizures have also been mentioned in single case report (SEDA-21, 377). 

Other isolated reports of ophthalmic abnormalities refer to optic neuritis with blurring of vision, cortical blindness with fatal encephalopathy, mononeural abducent nerve paralysis, and complete but reversible bilateral oculomotor nerve paralysis (SED-13,1096) (94-97). 

Merimsky O, Nisipeanu P, Loewenstein A, Reider-Groswasser I, Chaitchik S. Interferon-related cortical blindness. Cancer Chemother Pharmacol 1992 29(4) 329-30. 

A 64-year-old man developed transient cortical blindness after right subclavian, aortic, and femoral arteriography for ischemic pain in his left leg (100). lopromide 250 ml (iodine 300 mg/ml) was used. The patient was... 

After difficult cardiac angiography in the supine position, an elderly man with arteriosclerosis developed transient cortical blindness (102). On CT scan there was contrast enhancement of the occipital lobes. 

Sticherhng C, Berkefeld J, Auch-Schwelk W, Lanfermann H. Transient bilateral cortical blindness after coronary angiography. Lancet 1998 351(9102) 570. 

Boyes LA, Tew K. Cortical blindness after subclavian arteriography. Australas Radiol 2000 44(3) 315-17. 

Nakai Y, Hyodo A, Okazaki M, Shibata Y, Matsumaru Y, Nose T. [Transient cortical blindness and convulsion mimicking a hemorrhagic complication during embolization of the cerebellar AVM.] No Shinkei Geka 1999 27(3) 249-53. 

Parry R, Rees JR, WUde P. Transient cortical blindness after coronary angiography. Br Heart J 1993 70(6) 563-4. 

Rapid lowering of the blood pressure with nifedipine, particularly sublingually, can precipitate cerebral ischemia, with confusion, loss of consciousness, and stroke. Cases of cortical blindness with macular sparing secondary to occipital lobe infarction have been reported (SEDA-17, 238). 

Ocular effects, including optic neuritis, papilledema, and retrobulbar neuritis, are uncommon adverse effects of cisplatin-containing cancer chemotherapy. The risk of retinal toxicity is restricted to high-dose cisplatin therapy (for example 200 mg/m over 5 days) and can result in blurred vision and altered color perception, which can persist for several months. In contrast to cisplatin, carbo-platin is seldom involved in drug-induced visual disturbances. In two cases there was a relation between the administration of carboplatin (800-1200 mg/m ) and the occurrence of chnical cortical blindness (122). However, both patients had impaired renal function before the start of therapy with carboplatin. 

Al-Tweigeri T, Magliocco AM, DeCoteau JF. Cortical blindness as a manifestation of hypomagnesemia secondary to cisplatin therapy case report and review of literature. Gynecol Oncol 1999 72(l) 120-2. 

In addition to a normal eye, vision requires an intact circuit to and from the brain itself. The optic nerve (cranial nerve II), for example, carries retinal information to the occipital cortex in the posterior aspects of the brain. In addition, information concerning pupil size, direction of gaze, simultaneous movement of the eyes (conjugate gaze), and focus clarity is relayed from the brain back to the eye through multiple nerves. Ethambutol, an antituberculous medication, affects the optic nerves (optic neuropathy) whereas organic mercury compounds have been historically associated with toxic effects on the occipital cortex (cortical blindness). 

For various ophthalmological disorders, such as glaucoma, optic nerve atrophy, acute retrobulbar neuritis, cortical blindness, and central retinitis, add Flos Chrysanthemi Morifolii (Ju Hua), Fructus Lycii Chinensis (Gou Qi Zi), and Rhizoma Acori Graminei (Shi Chang Pu). 

Contralateral hemianopia or total cortical blindness if bilateral... 

---