Cortical blindness following aortic arch surgery.

PURPOSE: To report a patient with Marfan's syndrome in whom cortical blindness occurred after planned circulatory arrest during aortic arch surgery.

CASE: A 31-year-old man underwent aortic arch surgery because of an acute aortic dissection due to Marfan's syndrome. He noticed poor vision after surgery, although his pupillary reflexes and fundi appeared normal. Magnetic resonance imaging (MRI) and positron emission tomography (PET) were performed 2 years and 9 months after his operation.

RESULTS

The MRI revealed cortical atrophy in the occipital cortex, and PET scans with fluorodeoxy glucose revealed extreme glucose hypometabolism in the occipital cortex. The atrophy reflected cortical laminar necrosis that presumably occurred during the planned circulatory arrest to the brain during the surgery.

CONCLUSION

It is occasionally difficult to diagnose cortical blindness with MRI, especially at the acute stage. We could find significant hypometabolism of the occipital cortex using PET.