A 54-year-old non-diabetic woman complaining of chest pain with a history of myocardial infarction (MI) and percutaneous coronary intervention about 13 years ago was evaluated. Her drug history included nitroglycerin, atorvastatin, and, aspirin. Before the operation, her ejection fraction was 40% and the carotid Doppler showed no abnormality. Also, angiography revealed 80%, 90%, and 60% stenosis in the left anterior descending (LAD), diagonal artery, and right coronary artery respectively. Bypass grafts were implanted as the left internal mammary artery to the LAD artery, the saphenous vein to the obtuse marginal and ramus artery, however, right coronary artery bypass grafting was incapable. During surgery, the blood runoff was good. Additionally, iodinated contrast agent was used and the time of the operation and aortic clamp duration were 128 minutes and 70 minutes respectively.

The patient was asymptomatic after the operation but started to have bilateral blurring of vision three days after the surgery, which worsened drastically over 2 weeks. After this period, she only was able to perceive light bilaterally and her vision improved gradually for 2 months. After the surgery, vital signs were good, had no change of electrocardiogram or enzymes, and cardiac status was stable. The ophthalmology examination detected no causative ocular damage except bilateral papilledema and reduced visual acuity at the level of light perception. So, as the initial management, intravenous hydrocortisone was administrated (100 mg bd for three days). A non-contrast computed tomography (CT)-Scan revealed bilateral subarachnoid hyperdensities in the occipital and parietal lobes. Hence to confirm cerebral hemorrhage, magnetic resonance imaging (MRI) was done which showed no evidence of hemorrhage. The evaluation of related arteries (carotid, vertebral and ophthalmic) was completely normal. Nevertheless, the patient remained under close observation with no additional intervention. Finally, her vision completely recovered after two months and remained with no other complications during the further follow-up.