Visual loss and central venous catheterization: cortical blindness and hemianopsia after inadvertent subclavian artery entry.
A case of presumed embolic transient ischemic episodes and multifocal infarcts to the occipital and parietal cortices and the cerebellum of a young woman with ulcerative colitis is reported. These episodes were manifested by multifocal neurologic deficits including cortical blindness, visual hallucinations, and homonymous hemianopsia. They correlated with parenteral nutrition via a central line, presumed venous, but found to be in the subclavian artery. The complications of central venous lines are reviewed. The need for attention to neighborhood structures and unexpected symptoms, in view of the less well-recognized arterial embolic complications is emphasized.
Wang
R C
RC
William H. Havener Eye Center, The Ohio State University, Columbus, USA.
Katz
S E
SE
Lubow
M
M
D000328:Adult; D019575:Blindness, Cortical / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000150:complications; D005260:Female; D006212:Hallucinations / Q000209:etiology; D006423:Hemianopsia / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D010288:Parenteral Nutrition; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014792:Visual Acuity; D014794:Visual Fields