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Cortical Blindness

20 Jul

I have an interesting case that I’d like to share. Maybe someone as well would be able to help me identify any syndrome appropriate to describe it.

Prenatal background

One time, the mother was standing on one foot on a chair, while the other foot was over a stone wall. Suddenly she slipped, forcing her to fall to the ground, buttocks first. She did not consult nor informed anyone about this matter.

Labor room

Image

(Image courtesy of http://www.epubbud.com/read.php?g=XWL9CAZ3&p=1)

When the mother was at the labor room, on a dorsal lithotomy position, suddenly a sharp severe pain struck her right hip. When the obstetrician asked what was the matter, that was the only time she mentioned about slipping from a chair hitting the ground with her buttocks first. Because of this, she was instead scheduled for emergency cesarean section as she cannot bear down to deliver her baby.

Neonatal course

When the baby was born, and when he was stimulated to cry, one thing struck me instantly. His cry was very different, very very peculiar. It was in a staccato. Later, I also noted baby to have jerky movements. This then told me that something was wrong with the baby. I worked up the baby considering the revelation of the mother at the labor room. First, I took serum electrolytes including magnesium – all were within normal values, so it means that the jerky and seizure-like movements were not because of electrolyte imbalance.

Next thing, we did an electroencephalogram studies (EEG) to see if there are epileptiform discharges from the brain that’s causing those abnormal, seizure-like movements. Lo and behold, an epileptiform discharges were being emitted by the right occipital lobe of the brain.

Then, to be able to document if this seizure is because of organic in origin (structural defect), I requested for a CT scan to check for presence of bleeding, tumor or any other brain structural abnormality. What’s your guess? Consider the history that happened to the mother before she gave birth. Yes, there was a dense mass at the brain that suggests a bleeding, an epidural hematoma. Naturally, you would think that the epidural hematoma would be located at the right occipital lobe as well, since that’s where the seizure discharges come from, right? Surprisingly, it isn’t. The epidural hematoma is located at the left fronto-temporal area, an area on the opposite side of the other half of the brain.

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Left epidural hematoma pointed by 2 small white arrows (not the actual case). Image courtesy of http://www.urmc.rochester.edu/smd/Rad/neurocases/Neurocase17.htm

This suggests a contrecoup brain injury that happened during the mother’s fall. It should be remembered that uterus will always protect the baby from external harm, trauma included. I was surprised of this finding in our patient. The patient was co-managed with a neurologist and when discharged he was maintained on anti-convulsant.

As months went by, and with serial follow-up with the neurologist, a sad development happened. He was diagnosed to be cortically blind. This means that the eyes can capture light (the eyes can see) and send it to the brain for interpretation. Unfortunately, because of the injury back then during pregnancy, the brain cannot interpret the lightwaves that the eyes see. Also, he was noted to be aphasic. He can not talk in words, but follows some commands by actions. His posture is that of tilting his head towards back and look at the source of the sound. Yes, this is something unfortunate event indeed. For good, he is very dependent on someone for his daily needs.

Image

Not the actual patient. This is just to illustrate the child’s posture. (Photo courtesy of www.cpfamilynetwork.org/patient-care/how-i-got-medicaid-to-pay-for-disposable-diapers)

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Posted by on July 20, 2012 in neonates, Pregnancy

 

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