A Rare Case of Ischemic Optic Chiasmopathy Following Left Ventricular Dysfunction in a Patient with Coronary Artery Disease

We report a case of transient bitemporal hemianopia following a hypotensive episode in a patient of coronary artery disease (CAD). A 51-year-old male presented with anterior wall myocardial infarction (AWMI) and underwent percutaneous coronary artery intervention (PCI). On the second day post procedure, he developed an acute ischemic event following a cardioembolic infarct to the left middle cerebral artery (MCA) region. Over the next few days, the patient had persistent drop in blood pressure, during which he developed a transient bitemporal hemianopia, which improved after blood pressure correction, consistent with ischemic chiasmopathy. As such in literature, ischemic optic chiasmopathy is a very rare entity. This case report emphasizes that clinicians should consider that sustained hypotension associated with a cardiac event may lead to transient ischemic phenomenon such as the witnessed visual impairment due to hypoperfusion of the optic chiasm.