Emergency department presentation with cortical blindness and visual field defects suggests which head injury?

• A. Cerebral contusion
• B. Orbital skull fracture
• C. Posterior fossa fracture
• D. Frontal lobe skull fracture

Answer: (C)

Cortical blindness means loss of vision due to damage to the occipital visual cortex, not problems with the eyes or optic nerves. The occipital lobes sit at the back of the brain, near the skull’s posterior base. A fracture in the posterior fossa can injure the occipital lobes or their blood supply, producing cortical blindness and visual field defects even if the eyes themselves are intact. This pattern fits best with a posterior fossa fracture.

Other injuries described are less consistent with cortical blindness. An orbital skull fracture could damage the eye or optic nerve and cause vision loss, but it wouldn’t typically present as cortical blindness with visual field deficits tied to occipital cortex injury. A frontal lobe fracture would more often affect personality, executive function, or motor behavior, not primary vision. A cerebral contusion could cause vision problems if it involves the occipital region, but the question’s clue points specifically to the posterior fossa as the site linked to occipital cortex injury.