Abstract
Transient cortical blindness (TCB) is a rare complication of cerebral angiography, with a reported incidence of 0.3-1%. We report a 46-year-old male with a giant thrombosed left V4 vertebral aneurysm (38 × 42 × 30 mm) who developed acute bilateral total visual loss approximately four hours after transfemoral cerebral angiography (TFCA) using iodixanol 320 mg.
Notably, the patient initially denied any visual loss, raising the consideration of Anton syndrome — a condition characterized by cortical blindness with visual anosognosia and confabulation. Emergency evaluation revealed visual acuity of 1/? bilaterally, with normal pupillary reflexes and fundoscopic findings. Post-procedural neuroimaging showed no evidence of acute infarction, posterior reversible encephalopathy syndrome, or contrast extravasation. Treated conservatively with dexamethasone and mannitol, vision recovered fully within 72 hours.
Two principal mechanisms underlie TCB: blood-brain barrier disruption from contrast neurotoxicity, and posterior reversible encephalopathy syndrome from impaired cerebral autoregulation. The giant V4 aneurysm may have augmented posterior circulation vulnerability through local mass effect.
This case illustrates that TCB may be missed when the patient confabulates intact vision, and that Anton syndrome should be considered whenever anosognosia accompanies post-angiographic visual loss.
