Contrast media induced transient cortical blindness.

A 60-year-old man who had previous coronary artery bypass graft surgery with a left internal mammary artery (LIMA) graft, underwent a coronary angiogram to investigate multiple episodes of angina. His only other significant past medical history was well-controlled hypertension. The patient was previously exposed to iodinated contrast media with no history of reaction. His pre-procedural blood pressure and renal function was noted to be normal. No premedication was used. During injection of the LIMA, the patient complained of blurring of vision which deteriorated to near total blindness within minutes. On examination, the patient was able to only differentiate light from dark and unable to do finger counting. The pupils were equal in size and responsive to light. The rest of the neurological examination was normal. The blood pressure during the procedure was high (190/100 mmHg) and the patient also complained of a headache. The procedure was abandoned and a Computed tomography (CT) brain was requested urgently. The plain CT brain revealed symmetrical subarachnoid and gyral hyperdensity in both occipital lobes (Figure 1). No effacement of the sulci or