Amaurosis Following Blood Loss

Presencia, A. Caballero; Hernández, Alicia Martínez; Guía, E Díaz

doi:10.1159/000309571

Cited by 22 publications

(3 citation statements)

References 9 publications

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“…[ 21 ] With this belief, orthopedic surgery was not delayed and antiplatelet agents were not given to our patient to reduce the risk of complications from multiple bone fractures. Accordingly, the occurrence of perioperative visual loss, which is an uncommon complication primarily associated with cardiac, spine, and head and neck surgery, [ 22 ] also did not raise the concern of thromboembolic event in our patient because the initial possible diagnosis of visual loss was considered to be related to hypovolemic shock [ 23 , 24 ] or FES. Not until the progression of neurological symptoms from visual loss to limb weakness did we realize that thromboembolism may be a possibility.…”

Section: Discussionmentioning

confidence: 98%

Bilateral visual loss and cerebral infarction after spleen embolization in a trauma patient with idiopathic thrombocytopenic purpura

Wang

Lin

et al. 2018

Medicine

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Rationale:Splenic artery embolization (SAE) is a common procedure in trauma patients with blunt splenic injuries. We report a case of acute ischemic stroke following orthopedic surgery in a patient with post-SAE reactive thrombocytosis.Patient concerns:A 37-year-old woman with idiopathic thrombocytopenic purpura (ITP) suffered from multiple trauma scheduled for open reduction and internal fixation for right tibial and left radius fracture five days after SAE. The patient did not have any thromboembolic complications, although the platelet counts increased from 43 × 109/L to 568 × 109/L within two days after SAE. Surgery was completed under general anesthesia with tracheal intubation without complications. The patient complained of visual loss followed by limb weakness on the fourth and eighth hour postoperatively.Diagnoses:Magnetic resonance imaging (MRI) of head demonstrated ischemic change over bilateral basal ganglia, and occipital areas, suggesting the diagnosis of cortical blindness.Interventions:To suppress platelet count and avoid platelet hyper-aggregation, anti-platelet drug (i.e., oral aspirin 100 mg daily), hydration, and hydroxyurea (i.e., 20 mg/kg daily) were used for the treatment of reactive thrombocytosis.Outcomes:Although right-sided hemiparesis persisted, the patient reported mild visual recovery. She was discharged four months after SAE with active rehabilitation.Lessons:Our report highlights an increased risk of acute arterial thromboembolic events in patients with reactive thrombocytosis, especially those undergoing surgery.

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Section: Discussionmentioning

confidence: 98%

Bilateral visual loss and cerebral infarction after spleen embolization in a trauma patient with idiopathic thrombocytopenic purpura

Wang

Lin

et al. 2018

Medicine

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“…All six cases were associated with relative risk factors of blood loss, perioperative anemia with a hemoglobin level less than 8 gm/dl, and hypotension with a decrease in mean blood pressure ranging from 24% to 46% (from preoperative levels) for 15 minutes. Presencia et al 12 have noted that in all documented cases of bilateral complete amaurosis, the hemoglobin level is invariably less than 5.0 gm/dl. Johnson et al 13 presented the histologic findings of bilateral retrobulbar optic nerve infarctions causing visual loss after hemorrhage and hypotension.…”

Section: Discussionmentioning

confidence: 98%

Delayed Blindness after Facial Fracture Repair

Caradonna

Lauretano

et al. 1997

Otolaryngol.--head neck surg.

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“…Visual loss from blood loss has been well described 3–7 . Perioperative hypotension and anaemia has been noted to cause ischaemic optic neuropathy after a wide range of major surgery.…”

Section: Discussionmentioning

confidence: 99%

Upside‐down orbitopathy: unilateral orbital dependent‐tissue oedema causing total visual loss

Fuller

Vote

2001

Clinical Exper Ophthalmology

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The case is reported of a 24-year-old man who was involved in a road traffic accident and became trapped upside down with the right side of his face being the most dependent part of his body. Marked hemifacial tissue oedema was associated with right acute compressive orbitopathy and vascular compromise. Acute dysfunction of al orbital nerves was found on examination. Such neuropathy is usually related to the consequences of direct trauma, fractures or haemorrhage; however, computed tomography scanning demonstrated no evidence of orbital fracture or haemorrhage. Immediate anterior surgical orbital decompression was performed in the emergency room in addition to high dose intravenous steroids. Dependent orbtal tissue oedema is proposed as a mechanism of compressive orbitopathy with consequent ischaemic damage to all orbital nerves, total visual loss and complete ophthalmoparesis. Good recovery of other orbital nerves has occurred and the globe has reperfused. Despite intervention, no visual function has returned.

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Amaurosis Following Blood Loss

Cited by 22 publications

References 9 publications

Bilateral visual loss and cerebral infarction after spleen embolization in a trauma patient with idiopathic thrombocytopenic purpura

Bilateral visual loss and cerebral infarction after spleen embolization in a trauma patient with idiopathic thrombocytopenic purpura

Delayed Blindness after Facial Fracture Repair

Upside‐down orbitopathy: unilateral orbital dependent‐tissue oedema causing total visual loss

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