97th DOG Annual Meeting 1999



E. Müller, W. Huk, E. Pauli, H. Wenkel

The Wada test is an important presurgical diagnostic tool in epileptic patients. Following contrast radiography of cerebral vasculature, sodium amytal is injected into the carotid artery to produce a short-term anesthesia of one hemisphere. During this procedure neurophysiological tests allow a characterization of the cerebral speech representation. This information is important to determine the dimension of a planned neurosurgical resection.

Patient: A 22-year old male with idiopathic epilepsy and without anamnestic thrombembolic complications presented in the eye hospital after he had noticed a shadow in the central visual field of his right eye immediately after Wada test.

Findings: The visual acuity of the right eye was 20/40. The fundus showed two small regions of edematous retina between macula and optic disc. Computerized perimetry revealed wide scotomas in the 10° area. Flourescein angiography revealed a slowly increasing patchy hyperfluorescence localized at the temporal rim of the optic disc with a slightly delayed venous filling. These angiographic findings were compatible with an occlusion of two small branch retinal arteries. A follow-up examination four months later revealed a visual acuity of 20/20. The intraretinal edema had disappeared, but the temporal part of the optic disc was pale. The paracentral scotomas were slightly decreased.

Discussion: To our knowledge branch retinal artery occlusions have not been described as complications of the Wada test. Apart from blood clots spread by catheterization, embolization by undissolved contrast medium or sodium amytal could be responsible.

Department of Ophthalmology, Department of Neurology and Department of Neuroradiology, University of Erlangen-Nürnberg