Case report
Valsalva-maneuver induced recurrent transient bilateral visual loss

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Background

Valsalva-maneuver – a voluntary increase in thoracic pressure by forced expiration against closed airway, e.g. by closing mouth and nose – may consecutively lead to increase of intracranial pressure (ICP). Increased thoracic pressure results in reduced venous return, including venous drainage from intracranial, thus leading to increase of ICP [1].

Increased ICP may lead to visual obscuration, as frequently observed in idiopathic intracranial hypertension. Also, Valsalva-maneuver has been shown

Case presentation

A 44-year old male patient presented with a 6 months history of isolated painless transient visual loss following physical activity associated with Valsalva-maneuver (e.g. lifting or carrying heavy loads). In addition, but less frequently, symptoms would arise when bending forward. Visual loss could last one to two minutes, affect each eye separately or both eyes concomitantly and would gradually resolve within minutes. The right eye had been affected first, followed by the left eye a few weeks

Discussion

Overall, we present a unique clinical case of reproducible transient blindness with an afferent pupillary defect related to Valsalva-maneuver, with reproducibly abolished flash-VEP. Since detailed diagnostic (especially ophthalmologic) work-up was unremarkable, the pathomechanism of this unique clinical finding remains elusive. The only finding was bilateral compression of the pre-chiasmatic optic nerve by the ectatic ICA. The localisation of this finding would in general be compatible with the

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