Abstract
Non arteritic ischemic optic neuropathy (NAION) with consequent visual loss is recognised and serious outcome following spinal and cardiac surgery. We describe a patient in her 70s who developed sequential bilateral complete blindness and a thrombosed orbital varix post spinal surgery. This case highlights the atypical presentation for NAION and the role of prone positioning, ocular blood flow and hypoxia.
A lady in her 70s was transferred to a tertiary hospital for management of an L1 fracture and cauda equina. She had worsening lower limb weakness and urinary incontinence post a fall 6 months ago prior to the presentation. She underwent posterior decompression + fusion of T12-L2 in a prone position. Immediately post-op, the patient developed blurred vision in the upper quadrant of her left eye. The postoperative period was also complicated by an episode of reduced consciousness level which was thought to be secondary to opioids. A CT head identified a left superior ophthalmic vein varix with potential thrombosis. Ophthalmology review noted mild inferior blurred discs, but examination was considered within normal limits and CT findings were considered incidental.
Two weeks later she reported to staff that the vision in her right had become dull and blurred over the last 24 hours. Ophthalmology assessment which showed bilateral optic swelling and was then admitted for further work-up of her bilateral vision loss. Her vision continued to deteriorate during her stay. Lumbar puncture, MRI Brain/Spine, temporal artery ultrasound and temporal artery biopsy did not reveal any obvious abnormality.
