Illustrative case of prosopagnosia after diagnostic cerebral angiography and systematic review of transient cortical blindness after cerebral angiography

Background Transient cortical blindness is a rare complication after cerebral angiography. We report an unusual case of face blindness (prosopagnosia) in a patient who underwent diagnostic cerebral angiography for an incidentally discovered left middle cerebral artery aneurysm. The patient experienced difficulty recognizing faces 3 hours postprocedure, with resolution of symptoms within 24 hours. Objective To carry out a systematic review of transient cortical blindness after cerebral angiography to investigate factors associated with, and management of, this rare phenomenon. Methods The review was conducted using PubMed and Embase, with search terms related to cerebral angiography and transient blindness. Included studies reported transient cortical blindness after diagnostic or interventional cerebral angiography and detailed patient demographics, procedural specifics, onset and resolution of blindness, and postprocedural imaging findings. Results Twenty-two articles involving 63 patients were identified. Most cases (n=54, 85.7%) were associated with diagnostic procedures. All nine interventional cases involved cerebral aneurysm treatments. Forty-two (66.7%) patients experienced complete blindness, with an average onset of 2 hours postprocedure and resolution within 82 hours (range 6 hours–21 days). Postprocedural neuroimaging abnormalities were observed in 24 (53.3%) cases, mainly showing contrast enhancement in the occipital lobe. All patients recovered vision. Conclusions Our review highlights the rarity of prosopagnosia after cerebral angiography, a rare variant of cortical blindness. The findings suggest that cortical blindness resolves spontaneously within a short period. Although complete visual loss is more commonly reported in the literature, facial recognition deficits are rare. Awareness of transient cortical blindness after cerebral angiography is essential for accurate diagnosis and management.