Clinicoradiologic Findings and Prognosis of Cortical Blindness

J Korean Neurol Assoc > Volume 20(4); 2002 > Article

Journal of the Korean Neurological Association 2002;20(4): 359-364.

피질맹의 임상 및 방사선 소견과 예후

김정은, 박기덕 ·오지영 ·김지현 ·권영주 ·김용재 ·최경규

이화여자대학교 의과대학 신경과학교실

Clinicoradiologic Findings and Prognosis of Cortical Blindness

Jung-Eun Kim

Department of Neurology, College of Medicine, Ewha Womans University

Abstract

"Background : Cortical blindness is one of the less known clinical syndromes caused by bilateral occipital lobe lesions. The most common etiology is bilateral posterior cerebral artery (PCA) infarction, and the prognosis has been reported to be bad and incomplete. Methods : We reviewed our registry from January 1999 to March 2002, and found seventeen patients who were diagnosed with cortical blindness. We analyzed their clinical features, neurologic exami-nations, radiologic findings, electrophysiological studies, and follow up their visual acuities. Results : Of the sixteen cases, ten were bilateral PCA infarction, three were postpartum eclampsia, two were cyclosporin-induced blindness and the other was the case recovered from cardiac arrest. Most patients presenting symptoms were headache and sudden visual loss, ranged from finger count to complete blindness. There were two patients with complete blindness. On the follow up examination, twelve patients regained some visual acuity. The wider lesion involved bilateral occipital lobes; the worse was initial visual acuity. The prognosis was better when the lesion size was small and extrastriate cortex was spared. The electroencephalography and visual evoked potential findings were compatible with clinical symptom, but not exactly correlated with the prognosis. Conclusions : Contrary to the general concept that cortical blindness is caused by bilateral occipital lobe infarction has a poor prognosis, our cases showed a fair outcome of vision. It was a good predictor for prognosis whether extrastriate cortex was spared or not, suggesting its role in visual recovery.Key Words : Cortical blindness, Occipital lobe, Posterior cerebral artery, Extracalcarine cortex, Prognosis"