Cortical Blindness Following Neonatal Hypoxic Ischaemic Encephalopathy: Cases Series from Bamako

Purpose: Report of series of cases of cortical blindness that occurred after neonatal hypoxic-ischaemic by analysing its epidemiological frequency in black Africa. Methodology: This is the report of two clinical cases received in consultation on Monday 16th November 2020 and Thursday 7th January 2021 in the paediatric ophthalmology department of the IOTA-University Hospital. Results: They are two infants, aged 05 and 17 months respectively, who were brought in for consultation by their mother for lack of eye-tracking movement since birth. Both infants were born at term following a dystocic delivery. At birth, both infants had a very poor Apar score and were given a resuscitation treatment. The clinical examination coupled with the results of the paraclinical examinations allowed us to conclude at cortical blindness induced the neonatal hypoxic-ischaemic encephalopathy. Their therapeutic management, in collaboration with the neurologist, included the combination of piracetam suspension and Valproate sodium syrup. The evolution after three months of treatment is marked by the regression of epileptic seizures and the perception of light. Conclusion: In black Africa, neonatal hypoxic-ischaemic encephalopathy is the second leading cause of cortical blindness in children, after the neuromalaria sequels.

Transient cortical blindness in fat embolism syndrome—a diagnostic enigma

Fat embolism syndrome(FES)is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman’s triad of dyspnea,petechiae and mental confusion.While fat embolization into systemic circulation is common,FES occurs in a meagre 0.05%e3%of patients having isolated long bone fractures.Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence,it may not always be the case.Cortical blindness has been seldom reported in association with FES,and less so as a presenting complaint.Furthermore,no previous literature has described the same in context of an isolated tibia fracture.We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints.Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum.He later went on to develop altered mentation,hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes.Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia.The perioperative period was uneventful and he was discharged following staple removal.At one month of follow-up,the patient had no residual visual field defects or neurological deficits.Though FES is rare among isolated tibia fractures,this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.

Fundus changes in pregnancy induced hypertension

AIM: To determine the prevalence of retinal changes in pregnancy induced hypertension (PIH) and any association between the retinal changes and blood pressure, proteinuria, and severity of the disease. METHODS: All the patients admitted with diagnosis of PIH were included in this study. Age, race, gravida, gestation period, blood pressure, and proteinuria were noted from the case records. After taking history for any eye symptoms, fundus examination was done after dilating the pupils with direct ophthalmoscope in the ward itself. All the findings were noted on a data sheet, and were analyzed using SPSS programme. RESULTS: A total of 78 patients of PIH were examined. Majority (75.6%) were Malays. The mean age of patients was 30.2 years (range 21-45 years). The gestation period ranged from 25 weeks to 41 weeks; 34 (43.5%) were primi gravida. Thirty (38.4%) patients had mild preeclampsia, 46 (59%) had severe preeclampsia and 2(2.5%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in 46 (59%) patients --- grade I in 41 (52.6%) and grade II in 5 (6.4%). Haemorrhages or exudates or retinal detachment were not seen in any patient. There was statistically significant positive association of retinal changes and blood pressure (P =0.001), proteinuria (P =0.018) and severity of the PIH (P =0.024). CONCLUSION: Retinal changes (grade I and II hypertensive retinopathy) were seen in 59% of patients with PIH and they were significantly associated with blood pressure, proteinuria and severity of the disease. Fundus examination helps in assessing the severity of PIH.

Visual Anosognosia (Anton-Babinski Syndrome): Report of Two Cases Associated with Ischemic Cerebrovascular Disease

Visual anosognosia or Anton-Babinski syndrome is a rare neurological condition related to cortical blindness. The patients deny their blindness and affirm adamantly that they are capable of seeing. The clinical presentation includes confabulations and sometimes confusional states. In this article we report two patients with anosognosia related to ischemic stroke in two different sets of etiology and pathogenesis. We describe the major clinical manifestations of this syndrome and review the current medical literature. Two patients were identified, a 96-year-old male with visual anosognosia secondary to a right posterior cerebral artery thrombosis, and a 56-year-old female with the same syndrome but related to central nervous system angiitis in relation with multiple sclerosis and Hashimoto’s thyroiditis. Visual anosognosia or Anton-Babinski syndrome is a rare neurological condition, however the ischemic vascular cerebral disease is a frequent etiology. We believe that this is the first report of this syndrome in relation to angiitis with a clear autoimmune pathogenesis.