Hypoxic brain trauma causing blindness in a multiple gunshot wound patient: a challenging clinical scenario with a brief review of the literature

Document Type : Case Report


1 Ross University School of Medicine, Barbados

2 College of Biomedical Sciences, Larkin University, Miami, Florida, USA

3 Physical Sciences Department, Broward College, Davie, Florida, USA


Background: Cortical Blindness is most commonly caused by stroke or traumatic brain injury. The case study has the unique function of outlining the story of a young patient who incurred multiple gunshot wounds in an incident that ultimately transpired into a complete and permanent cortical blindness.
Case presentation:  The present subject exhibits cortical blindness in the absence of either etiology. The proposed etiology is that of perioperative hypoxic seizures. Neuroanatomical and pathophysiological framework is established to elucidate the conditions surrounding the outcome.
Discussion: It is known that acute neuronal ischemia presents as drastically urgent to the tune of a five-minute intervention window, and it is learned that the prognosis of recovery from cortical blindness is statistically confined to an interval of around six months. Statistical context paves the way for a practical perspective on rehabilitation for patients with vision loss.


Main Subjects

  1. Sarkar S, Tripathy K. Cortical Blindness. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
  2. Rodrigues EM, Isolan GR, Becker LG, Dini LI, Vaz MA, Frigeri TM. Anatomy of the optic radiations from the white matter fiber dissection perspective: A literature review applied to practical anatomical dissection. Surg Neurol Int 2022;13:309. doi:10.25259/SNI_1157_2021 PMid:35928310 PMCid:PMC9345124
  3. Huff T, Mahabadi N, Tadi P. Neuroanatomy, Visual Cortex. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  4. Belov Kirdajova D, Kriska J, Tureckova J, Anderova M. Ischemia-Triggered Glutamate Excitotoxicity From the Perspective of Glial Cells. Front Cell Neurosci. 2020;14:51. doi:10.3389/fncel.2020.00051 PMid:32265656 PMCid:PMC7098326
  5. Hossmann KA. The hypoxic brain. Insights from ischemia research. Adv Exp Med Biol. 1999;474:155-69 doi:10.1007/978-1-4615-4711-2_14 PMID: 10635000
  6. Niquet J, Baldwin RA, Allen SG, Fujikawa DG, Wasterlain CG. Hypoxic neuronal necrosis: protein synthesis-independent activation of a cell death program. Proceedings of the National Academy of Sciences. 2003;100 (5):2825-30. doi:10.1073/pnas.0530113100 PMid:12606726 PMCid:PMC151425
  7. Grover V, Jangra K. Perioperative vision loss: A complication to watch out. J Anaesthesiol Clin Pharmacol. 2012;28(1):11-6. doi:10.4103/0970-9185.92427 PMid:22345938 PMCid:PMC3275941
  8. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006;105 (4): 652-9;867-8. doi:10.1097/00000542-200610000-00007 PMid:17006060
  9. Xu Y, Fan Q. Relationship between chronic hypoxia and seizure susceptibility. CNS Neurosci Ther. 2022;28(11):1689-1705. doi:10.1111/cns.13942 PMid:35983626 PMCid:PMC9532927
  10. Sadeh M, Goldhammer Y, Kuritsky A. Postictal blindness in adults. J Neurol Neurosurg Psychiatry. 1983;46(6):566-9. doi:10.1136/jnnp.46.6.566
    PMid:6410006 PMCid:PMC1027452
  11. M Das J, Naqvi IA. Anton Syndrome. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
  12. Sarwar A, Emmady PD. Spatial Neglect. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
  13. Corrow SL, Dalrymple KA, Barton JJ. Prosopagnosia: current perspectives. Eye Brain. 2016;8:165-175. doi:10.2147/EB.S92838 PMid:28539812 PMCid:PMC5398751
  14. Parvathaneni A, M Das J. Balint Syndrome. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  15. Saionz EL, Busza A, Huxlin KR. Rehabilitation of visual perception in cortical blindness. Handb Clin Neurol. 2022; 184: 357-373. doi:10.1016/B978-0-12-819410-2.00030-8 PMid:35034749 PMCid:PMC9682408
  16. Warner ME, Warner MA, Garrity JA, MacKenzie RA, Warner DO. The frequency of perioperative vision loss. Anesth Analg. 2001; 93(6):1417-21. doi:10.1097/00000539-200112000-00013 PMid:11726416
  17. Nuttall GA, Garrity JA, Dearani JA, Abel MD, Schroeder DR, Mullany CJ. Risk factors for ischemic optic neuropathy after cardiopulmonary bypass: a matched case/control study. Anesth Analg. 2001;93(6):1410-6 doi:10.1097/00000539-200112000-00012 PMid:11726415
  18. And KT, Kolmel HW. Patterns of recovery from homonymous hemianopia subsequent to infarction in the distribution of the posterior cerebral artery. Neuro-ophthalmology. 1991;11(1):33-9. doi:10.3109/01658109109009640
  19. Gray CS, French JM, Bates D, Cartlidge NE, Venables GS, James OF. Recovery of visual fields in acute stroke: homonymous hemianopia associated with adverse prognosis. Age Ageing. 1989;18(6):419-21. doi:10.1093/ageing/18.6.419 PMid:2629493
  20. Zhang X, Kedar S, Lynn MJ, Newman NJ, Biousse V. Natural history of homonymous hemianopia. Neurology. 2006;66(6): 901-5. doi:10.1212/01.wnl.0000203338.54323.22 PMid:16567709