The patient underwent DSA with injection of the right carotid and vertebral arteries, which revealed no vascular abnormalities. Two hours post-procedure, she developed acute bitemporal blurred vision with bifrontal headache and nausea, progressing to complete blindness over 90 minutes. Neurological examination revealed equal and reactive pupils, intact extraocular movements, absent blink to threat bilaterally, negative optokinetic response, and absent light and motion perception. Repeat CTA and MRI were unchanged from pre-procedure imaging. EEG showed no epileptiform activity. The temporal relationship to contrast exposure and stable neuroimaging excluded alternative diagnoses including pituitary apoplexy, acute stroke, posterior reversible encephalopathy syndrome, and seizure-related visual phenomena. Her visual symptoms completely resolved overnight with full vision restoration within 18 hours. Ophthalmological evaluation was normal, and she experienced no residual deficits.

This case emphasizes that TCB should be considered in patients developing acute visual symptoms after contrast-enhanced procedures. Though typically self-limited and reversible, early recognition prevents unnecessary interventions and reduces patient anxiety. Management is supportive, as demonstrated in this case. Judicious contrast use, particularly with posterior circulation injections, may help prevent TCB.