CASE A 13-year-old girl is struck by a vehicle while riding on a bicycle without a helmet. Bystanders stated that she was unconscious for about 3 minutes. On scene, she is alert and appropriate and complaining of a mild headache. She is noted to have a bleeding wound above her right ear. She states that she is unable to see anything and a brief exam in the field appears to confirm this. After 15 minutes, on a repeat exam before transport, her vision began to return and was almost completely restored by the time she arrived in the ED. CT revealed a small epidural hematoma, which was managed nonoperatively. Several days later, she remains well with normal vision.
Post-traumatic transient cortical blindness is a very rare but well described syndrome, with case reports dating from 1918. It is more common in children and generally has a good prognosis.
This is a type of cortical blindness, not a result of ocular pathology. Although the patient may report various degrees of blindness, the pupils will react normally to light.
Some cases occur after seemingly minor head injury.
Blindness may occur immediately following injury or after several minutes. It usually resolves within hours.
It may be associated with vasospasm of the occipital vessels and related ischemia as well as a higher risk of migraine in later life.
The differential diagnosis includes anxiety as well as non-traumatic causes of cortical blindness including shock, cervical spine fracture with vertebral artery injury, stroke, meningitis, and CO poisoning.
Optokinetic testing may help identify functional or causes.
Patients with psychogenic blindness demonstrate saccadic eye movements as the patient’s involuntarily tracks a moving object (typically a sheet of paper of a drum with striped lines).
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James W. - January 19, 2021 6:15 PM
I actually had cortical blindness when I was in junior high. I got beaten up on the playground and punched probably 15 to 20 times in the back of the head. I was blind for approximately 30 to 45 minutes afterwards. I had two or three concussions later in life as a teenager and whenever I get a concussion I would be blind for about a half hour to an hour afterwards. This is a really interesting segment based on my prior experience.