Delayed Onset Anton-Babinski Syndrome following Post-Hypoxic Cortical Injury: A Case Report

Year 2025, Volume: 27 Issue: 1, 109 - 112, 30.04.2025

Özlem Önder , Şahin Işik

https://doi.org/10.18678/dtfd.1607544

Abstract

Delayed post-hypoxic cortical blindness is a rare but clinically significant condition that can manifest days or weeks following a hypoxic event, such as cardiac arrest. During these events, the brain is deprived of oxygen and glucose, leading to selective vulnerability in metabolically active regions, particularly the occipital lobes. Although initial resuscitation may restore spontaneous circulation, secondary injury mechanisms can contribute to delayed and progressive neurological damage. Here, a case of Anton-Babinski syndrome manifesting as sudden cortical blindness and profound anosognosia following successful cardiopulmonary resuscitation was reported. Despite undeniable visual loss confirmed by bilateral occipital ischemia on neuroimaging, the patient insisted she could see and provided confabulatory descriptions, highlighting a rare and intriguing complication of post-hypoxic injury. This case provides a unique perspective to the limited literature on Anton-Babinski syndrome, highlighting the critical importance of early recognition and comprehensive evaluation in uncovering rare and elusive post-hypoxic complications.

Keywords

cardiac arrest, hypoxia, cortical blindness, cerebral ischemia, hypoxic-ischemic encephalopathy, reperfusion injury, Anton-Babinski syndrome.

Post-Hipoksik Kortikal Hasar Sonrası Gelişen Gecikmiş Anton-Babinski Sendromu: Olgu Sunumu

Abstract

Gecikmiş post-hipoksik kortikal körlük, kardiyak arrest gibi hipoksik olayları takiben günler veya haftalar sonra ortaya çıkabilen nadir ancak klinik olarak önemli bir durumdur. Bu tür olaylar sırasında beyin, oksijen ve glukozdan yoksun kalır ve özellikle metabolik olarak aktif bölgelerden olan oksipital loblar seçici şekilde zarar görür. İlk resüsitasyon işlemi spontan dolaşımı geri kazandırsa da, ikincil hasar mekanizmaları gecikmiş ve ilerleyici nörolojik hasara katkıda bulunabilir. Bu yazıda, başarılı kardiyopulmoner resüsitasyon sonrası ani kortikal körlük ve belirgin anozognozi ile ortaya çıkan çarpıcı bir Anton-Babinski sendromu vakası sunulmuştur. Nörogörüntülemesinde bilateral oksipital iskemi ile doğrulanan belirgin görme kaybına rağmen hasta görebildiğini iddia etmiş ve çevresini hayali şekilde tanımlayarak konfabülasyon yapmıştır. Bu vaka, Anton-Babinski sendromu üzerine sınırlı veri içeren literatüre özgün bir katkı sağlamakta ve nadir görülen post-hipoksik komplikasyonların ortaya çıkarılmasında erken tanı ve kapsamlı değerlendirmenin kritik önemini vurgulamaktadır.

Keywords

kardiyak arrest, hipoksi, kortikal körlük, beyin iskemisi, hipoksik-iskemik ensefalopati, reperfüzyon hasarı, Anton-Babinski sendromu.

References

• Goodall S, Twomey R, Amann M. Acute and chronic hypoxia: implications for cerebral function and exercise tolerance. Fatigue. 2014;2(2):73-92.
• Jurcau A, Ardelean AI. Oxidative stress in ischemia/reperfusion injuries following acute ischemic stroke. Biomedicines. 2022;10(3):574.
• Diana L, Casati C, Melzi L, Bianchi Marzoli S, Bolognini N. The effects of occipital and parietal tDCS on chronic visual field defects after brain injury. Front Neurol. 2024;15:1340365.
• Ziaul YH, Mittal J, Afroze T, Kumar V. Anton-Babinski syndrome: A visual anosognosia. Cureus. 2024;16(3):e55679.
• Önder Ö, Kılıçaslan R. Delayed neuropsychiatric syndrome following carbon monoxide poisoning: Report of a rare case with response to treatment. J Emerg Med Case Rep. 2021;12(1):16-8.
• Chen JJ, Chang HF, Hsu YC, Chen DL. Anton-Babinski syndrome in an old patient: a case report and literature review. Psychogeriatrics. 2015;15(1):58-61.
• Yasir ZH, Sharma R, Khandekar R, Kesarwani D. Posterior cerebral artery stroke with visual manifestation during COVID pandemic. Indian J Clin Exp Ophthalmol. 2023;9(3):287-93.
• Majoulet A, Audo I, Goujard C, De Menthon M, Chaix F, Safar P, et al. Delayed-onset hypoxic cortical blindness: coming back from the abyss. Doc Ophthalmol. 2022;144(2):147-52.
• Sekhon MS, Stukas S, Hirsch‐Reinshagen V, Thiara S, Schoenthal T, Tymko M, et al. Neuroinflammation and the immune system in hypoxic ischaemic brain injury pathophysiology after cardiac arrest. J Physiol. 2024;602(21):5731-44.
• Rae CD, Baur JA, Borges K, Dienel G, Díaz‐García CM, Douglass SR, et al. Brain energy metabolism: A roadmap for future research. J Neurochem. 2024;168(5):910-54.
• Buonfiglio F, Böhm EW, Pfeiffer N, Gericke A. Oxidative stress: A suitable therapeutic target for optic nerve diseases? Antioxidants (Basel). 2023;12(7):1465.
• Saionz EL, Busza A, Huxlin KR. Rehabilitation of visual perception in cortical blindness. Handb Clin Neurol. 2022;184:357-73.