Paradoxical embolus causing transient bilateral blindness following spinal surgery.

摘要

Significant visual loss is a rare complication of spinal surgery, with an estimated occurrence of 1 case per 100 spine surgeons per year.1 Most reported cases of visual loss following spinal surgery have resulted from improper patient positioning, excessive blood loss, and intraoperative hypotension.A less commonly reported cause of postoperative visual complications is microembolization.Patients with an unrecognized atrial shunt, including patent foramen ovale, have an increased risk of microemboli circulating to the brain. Embolic events occur when right atrial pressure exceeds left atrial pressure. This pressure gradient can occur intraoperatively in response to mechanical ventilation, abdominal pressure, thromboembolism, or air embolism.