Transient Blindness in Pre-Eclakpsia: Two Cases and A Review of the Literature

Abstract

Two patients with severe pre-eclampsia in the third trimester of pregnancy developed sudden blindness. Physical examination and computed tomography indicated a central cause, most likely cerebral edema. Swan-Ganz catheterisation revealed a low cardiac preload and a markedly elevated afterload. Following pharmacologic reduction of the afterload the blindness disappeared completely.

On the basis of the two cases presented and a review of the pertinent literature we conclude that temporary cortical blindness in patients with severe pre-eclampsia may usually be attributed to focal cerebral edema. It seems likely that a combination of high cerebral arterial pressure, leading to disruption of capillary tight junctions, with an elevated interstitial cerebral colloid osmotic pressure constitutes the main determinant of fluid leakage into cerebral tissue. Treatment should consist of gradual pharmacologic reduction of mean arterial blood pressure.

Key Words:

• pre-eclampsia
• amaurosis
• cerebral edema
• Swan-Ganz catheterisation
• computed tomography