Loss of Vision as a Complication of Hysteroscopic Evaluation of Abnormal Uterine Bleeding

Idiopathic intracranial hypertension (IIH) which is commonly called pseudotumor cerebri, is a disorder defined by symptoms and signs of increased intracranial pressure such as headache, papilledema and vision loss with no other causes of intracranial hypertension evident on neuroimaging and with normal cerebrospinal fluid composition. IIH primarily affects women of childbearing age who are overweight.Abnormal uterine bleeding (AUB), is a common gynecologic problem and affects approximately 10 to 35 percent of women. PCOS is one of the most common endocrine disorders affecting women of reproductive age. It is associated with obesity, metabolic disorders, hypertension and abnormal uterine bleeding. Hysteroscopy provides a minimally invasive approach to abnormal uterine bleeding and also has the potential benefit of combining evaluation with treatment.A 36 years old lady G3 P2 (NVD) EP1 referred to an outpatient gynecologic clinic with severe headache, nausea, intermittent vomiting and subsequent bilateral visual dullness for two weeks, initiating a few hours after hysteroscopic evaluation of uterine cavity due to abnormal uterine bleeding. She was admitted for hysteroscopic evaluation of endometrial cavity two weeks ago and glycine1.5% was used as the distending media. There was no previous history of recent weight gain, hypertension, headache, drug administration or oral contraceptives use in her past history.She was hospitalized immediately in order to complete neurologic and ophthalmologic evaluation. The brain magnetic resonance imaging and venography studies were normal. The cerebrospinal fluid pressure was more than 50 cm H2o with the Hb value of 8.2. The other laboratory assessments were normal. The ophthalmologic studies showed peripheral visual loss which was worse on the left. Acetazolamide administration in addition to therapeutic lumbar puncture, blood transfusion and other conservative therapy was done and she discharged with the partial visual impairment which was more predominant at the left side. Further evaluations exhibited visual impairment lasted six months later in addition to irregular menstrual cycles.Discussion: Whether the complications are related to hysteroscopy or not is not certain. Media related electrolyte imbalance or anesthetic complication may have a role in this problem. In conclusion patients with PCOS are susceptible for IIH. Although gradual improvement develops with treatment, symptoms may worsen slowly and persistent papilledema, elevated intracranial pressure and permanent visual loss may occur. For these reasons more attention on fluid deficit and electrolyte balance is needed when hysteroscopic evaluations of AUB is purposed in patients with PCOS.

Keywords:

Idiopathic intracranial Hypertension , Hysteroscopy , Polycystic ovary Syndrome