50-year-old woman with history of hypertension presents with bilateral vision loss during follow up cerebral angiography for ruptured left internal carotid artery aneurysm status post coiling. This was associated with headache, nausea, and emesis. No associated neurologic deficits. Review of symptoms was otherwise negative. CT Head and CTA showed no acute abnormalities. MRI done on admission showed no evidence of abnormalities. Ophthalmology saw the patient and exam was unrevealing. After 24 hours her vision gradually improved and was back to baseline after 48 hours with no intervention. 

Transient Cortical Blindness is a rare but dramatic complication of cerebral angiogram. It is characterized by loss of perceived vision, normal fundi, normal papillary reflexes, and intact extraocular movements. Symptoms can occur at the start of the cerebral angiography procedure or until serval hours after. The recovery of normal vision may start within the first few hours, but may take as long as 5 days. Two hypothesis exist: could be due to a neurotoxic effect of contrast agent causing osmotic disruption of blood-brain barrier or could be the result of posterior reversible leukoencephalopathy syndrome leading to perivascular edema. There is no known treatment known to improve the condition.