Transient Cortical Blindness

Aka: Transient Cortical Blindness, Post-Traumatic Transient Cortical Blindness

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II. Epidemiology

  1. Most common in children

III. Pathophysiology

  1. May be associated with occipital vessel vasospasm following Head Trauma

IV. Symptoms

  1. Transient bilateral Vision Loss (resolves after minutes to hours)
  2. May occur after Minor Head Injury
  3. No Eye Injury

V. Signs

  1. Pupils with normal reactivity
  2. Normal Eye Exam

VI. Associated Conditions

  1. Migraine Headaches (in future)

VII. Differential Diagnosis

  1. Conversion Disorder (or other psychogenic blindness, Anxiety Disorder)
    1. Normal Eye Exam
    2. Reacts to visual threat
    3. Intact Optokinetic Reflex, Corrective Saccades or Nystagmus
      1. Eyes jerk back to initial position after following an object until out of Visual Field (full field motion)
  2. Occipital Epilepsy of childhood
    1. Seizure history
    2. Abnormal occipital findings on EEG
  3. Progressive Visual Scintillations followed by Headache
    1. Migraine Headache with Aura
  4. Increased Intracranial Pressure and Papilledema
    1. Idiopathic Intracranial Hypertension
    2. CNS Mass Lesion
  5. Toxins
    1. Methanol Poisoning
    2. Carbon Monoxide Poisoning
  6. Trauma
    1. Closed Head Injury
    2. Cervical Spine Fracture with Vertebral Artery injury
  7. Other causes
    1. Meningitis or Encephalitis

VIII. References

  1. Becker in Herbert (2020) EM:Rap 20(12): 6
  2. Iqbal in Teach (2019) Diagnostic Approach to Acute Vision Loss in Children, UpToDate, accessed 12/2/2020

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