Disclosures: Ovuokerie C. Addoh, MBBS, PhD: No financial relationships or conflicts of interest

Case Diagnosis: Bilateral Cortical Blindness.

Case Description or Program Description: A 44-year-old male chef suffered cardiopulmonary arrest following COVID-19 pneumonia. His airway was not secured for about ten minutes. Consequent complex acute care course involved a prolonged period of non-responsiveness. Complications included hypoxic-ischemic brain injury, with bilateral occipital infarcts and edema, which led to significant encephalomalacia.

Setting: He arrived at the rehabilitation unit about two months later.

Assessment/Results: As his mental status improved, he reported inability to see. Exam findings included intact light perception and pupillary reaction, inability to see hand motion or differentiate colors, no discernible blink reflex and negative optokinetic nystagmus drum response. Management involved a multidisciplinary team. Along with his speech, cognition, and motoric status, his vision slowly improved to 20/20 after correction and a central visual field of less than 20 degrees. He could reliably detect colors, large print, and objects. This improvement allowed him to participate in activities he liked, including cooking.

Discussion (relevance): Cortical blindness (CB) occurs following damage to the primary visual pathway (V1). Often, the extra-striate pathway (V2) is also affected. Damage to V1 or its afferents could occur in 27-57% of new strokes and is characterized by contralateral homonymous hemianopia with macular sparing. Bilateral destruction of V1 is rare. Some improvement with vision is anticipated within the first few months. However, significant residual deficits usually persist. There is sparse evidence for CB rehab modalities. Approaches to consider include restitution therapies (using computer-based training programs to recover visual field deficits), compensation therapies (using saccadic eye movements to capture blind fields), substitution therapies (using prisms to redirect stimuli to intact visual fields), and pharmacology to optimize neuroplasticity (fluoxetine appears to have shown some benefit for visual pathway in rodents).

Conclusions: Bilateral CB is a rare complication following brain injury. Although evidence-based treatment modalities are needed, support in a multidisciplinary framework was beneficial for optimizing outcomes in this unique case.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-cortical-blindness-following-hypoxic-ischemic-brain-injury-related-to-covid-19-a-case-report/