Transient Cortical Blindness Following Cervical Transforaminal Epidural Injection

Purpose: To report a case of transient cortical blindness following cervical transforaminal epidural injection.Case summary: A 58-year-old diabetic and hypertensive male was referred to the ophthalmology department with sudden-onset bilateral visual disturbances after cervical transforaminal epidural injection for neck pain. During the procedure, an intravascular contrast medium was injected into the left vertebral artery. Immediately after the injection, the patient complained of bilateral visual disturbances, mild headache, and dizziness. Twelve hours after the procedure, his visual acuity was reduced to hand motion perception in both eyes. Anterior segment and fundus examinations were unremarkable. Pupillary light reflexes and extraocular muscle movements were normal. Brain magnetic resonance imaging, magnetic resonance angiography, and fluorescein angiography showed no significant findings. There were no other neurological abnormalities. The patient was treated conservatively with intravenous dexamethasone and nimodipine based on a provisional diagnosis of transient cortical blindness. The symptoms gradually improved 2 days after the procedure; visual acuity recovered to 20/20 by the third day.Conclusions: Although contrast-induced transient cortical blindness is rare, it should be considered in patients with bilateral visual loss after transforaminal epidural injection. It is a benign and reversible condition but requires a prompt diagnosis.