Case ReportBilateral non-arteritic anterior ischemic optic neuropathy following second-trimester spontaneous abortion-related haemorrhage
Introduction
Non-arteritic ischemic optic neuropathy (NAION) is an ischemic process of the anterior portion of the optic nerve characterized by sudden, painless visual loss. Typically, NAION affects the elderly and is associated with risk factors such as diabetes mellitus, systemic hypertension and optic disc morphology (small and crowded optic disc).[1], [2] However, in younger patients, NAION is usually related to massive blood loss with resultant hypotension, and it has been reported after several surgical procedures, including spinal and cardiac surgery but rarely after trauma or obstetric haemorrhage.[2], [3], [4], [5], [6] Here we report a patient with bilateral NAION after abortion that resulted in a unilateral visual impairment. To our knowledge, this is a unique case presented after spontaneous abortion.
Section snippets
Case report
A 34-year-old woman was referred to our clinic three days after spontaneous abortion with visual loss in her left eye. She first complained about blurred vision two days after the abortion. Her medical history was unremarkable. She had four healthy children and no history of prior miscarriages. During her fifth pregnancy recurrent vaginal bleeding began during the fourth gestational week and complicated the pregnancy until a spontaneous abortion at the 20th week. Presumed uterine atony led to
Discussion
The pathophysiologic mechanisms causing NAION are unclear. The proposed mechanisms are decreased perfusion pressure in short posterior ciliary arteries (paraoptic branches) due to hypotension, impaired autoregulation with release of vasoactive amines, vasculopathy and venous insufficiency.[2], [7] The presence of a crowded disc (small cup-to-disc ratio) is considered an important anatomical risk factor that results in a compartment syndrome after axonal oedema.[1], [2] Additional risk factors,
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