When the liver fails, vision fades: A case of hepatic encephalopathy leading to cortical blindness

Abstract

Cortical blindness is an uncommon but recognized neurological complication of hepatic encephalopathy, and its occurrence has been linked to several underlying pathophysiological mechanisms. The aim of this report was to describe the clinical presentation of cortical blindness in a patient with hepatic encephalopathy and to discuss the potential mechanisms and diagnostic implications associated with this condition. A 50-year-old woman presented with sudden, complete bilateral visual loss after four days of abdominal pain, bloating, nausea, constipation, and abdominal distension. Progressive and painless visual deterioration had been experienced over the preceding two weeks. A four-year history of cirrhosis with poor treatment adherence was noted. On examination, the Glasgow Coma Scale (GCS) score was 13, and scleral icterus was not observed. Both pupils were round and reactive to light. However, no light perception was detected in either eye. The anterior segment examination was unremarkable, whereas ascites and peripheral edema were identified. Abdominal ultrasonography revealed hepatic cirrhosis, splenomegaly, and ascites. Electroencephalography and magnetic resonance imaging were not performed. Cortical blindness secondary to grade II hepatic encephalopathy was diagnosed, and therapeutic paracentesis was performed. However, neither the level of consciousness nor visual function improved after two days of hospitalization, and the patient was subsequently referred to a tertiary hospital. The patient died three days after admission to the referral hospital. In this patient, visual loss occurred in the setting of hepatic encephalopathy and decompensated cirrhosis. Although visual recovery may occur following prompt management, prolonged metabolic disturbance may result in irreversible cortical injury.