Piyush Kohli1, K N Jayasri2, A Rupa3, Mahesh Kumar2, A Kowsalya2. 1. Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India. kohli119@gmail.com. 2. Department of Neuro-Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India. 3. Department of Pediatric Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
Abstract
PURPOSE: To report the electrophysiological and neuroimaging findings in a patient who developed visual loss after attempted suicide by hanging. METHODS: A 45-year-old male presented with bilateral visual loss and difficulty in walking following a suicide attempt by hanging six months ago. He underwent a complete ophthalmologic examination, posterior segment optical coherence tomography (OCT), various electrophysiological tests and neuroimaging. RESULTS: His bilateral best-corrected visual acuity was logMAR 1.08. Intraocular pressures and ocular examination were normal except for bilateral temporal disk pallor. Macular OCT showed bilateral ganglion cell layer-inner plexiform layer complex thinning. Electroretinogram showed reduced b/a wave amplitude ratio in all the dark- and light-adapted International Society for Clinical Electrophysiology of Vision protocols in both the eyes. Pattern-reversal visually evoked potential (VEP) showed delayed latency of the P100 component in both the eyes. Electrooculography showed a normal light peak-to-dark trough ratio in both the eyes. Magnetic resonance imaging (MRI) brain showed chronic infarct and gliosis in both the occipital lobes. MR angiography showed pruning of P4 segments of both the posterior cerebral artery. Perfusion imaging showed reduction of perfusion in both the parieto-occipital lobes. CONCLUSION: Hanging survivors can develop visual loss after their recovery. The visual loss may be a result of simultaneous ischemic insult to the occipital lobe cortex, optic nerve and retina.
PURPOSE: To report the electrophysiological and neuroimaging findings in a patient who developed visual loss after attempted suicide by hanging. METHODS: A 45-year-old male presented with bilateral visual loss and difficulty in walking following a suicide attempt by hanging six months ago. He underwent a complete ophthalmologic examination, posterior segment optical coherence tomography (OCT), various electrophysiological tests and neuroimaging. RESULTS: His bilateral best-corrected visual acuity was logMAR 1.08. Intraocular pressures and ocular examination were normal except for bilateral temporal disk pallor. Macular OCT showed bilateral ganglion cell layer-inner plexiform layer complex thinning. Electroretinogram showed reduced b/a wave amplitude ratio in all the dark- and light-adapted International Society for Clinical Electrophysiology of Vision protocols in both the eyes. Pattern-reversal visually evoked potential (VEP) showed delayed latency of the P100 component in both the eyes. Electrooculography showed a normal light peak-to-dark trough ratio in both the eyes. Magnetic resonance imaging (MRI) brain showed chronic infarct and gliosis in both the occipital lobes. MR angiography showed pruning of P4 segments of both the posterior cerebral artery. Perfusion imaging showed reduction of perfusion in both the parieto-occipital lobes. CONCLUSION: Hanging survivors can develop visual loss after their recovery. The visual loss may be a result of simultaneous ischemic insult to the occipital lobe cortex, optic nerve and retina.