Case
A 54-year-old non-diabetic woman complaining of chest pain with a
history of myocardial infarction (MI) and percutaneous coronary
intervention about 13 years ago was evaluated. Her drug history included
nitroglycerin, atorvastatin, and, aspirin. Before the operation, her
ejection fraction was 40% and the carotid Doppler showed no
abnormality. Also, angiography revealed 80%, 90%, and 60% stenosis in
the left anterior descending (LAD), diagonal artery, and right coronary
artery respectively. Bypass grafts were implanted as the left internal
mammary artery to the LAD artery, the saphenous vein to the obtuse
marginal and ramus artery, however, right coronary artery bypass
grafting was incapable. During surgery, the blood runoff was good.
Additionally, iodinated contrast agent was used and the time of the
operation and aortic clamp duration were 128 minutes and 70 minutes
respectively.
The patient was asymptomatic after the operation but started to have
bilateral blurring of vision three days after the surgery, which
worsened drastically over 2 weeks. After this period, she only was able
to perceive light bilaterally and her vision improved gradually for 2
months. After the surgery, vital signs were good, had no change of
electrocardiogram or enzymes, and cardiac status was stable. The
ophthalmology examination detected no causative ocular damage except
bilateral papilledema and reduced visual acuity at the level of light
perception. So, as the initial management, intravenous hydrocortisone
was administrated (100 mg bd for three days). A non-contrast computed
tomography (CT)-Scan revealed bilateral subarachnoid hyperdensities in
the occipital and parietal lobes. Hence to confirm cerebral hemorrhage,
magnetic resonance imaging (MRI) was done which showed no evidence of
hemorrhage. The evaluation of related arteries (carotid, vertebral and
ophthalmic) was completely normal. Nevertheless, the patient remained
under close observation with no additional intervention. Finally, her
vision completely recovered after two months and remained with no other
complications during the further follow-up.