Presentation
Right-sided blurred vision with homonymous hemianopia. There is a partial regression of symptoms at presentation.
Patient Data
Hazy hypodensity with mild loss of gray-white differentiation in the left occipital lobe (primary and secondary visual areas).
Poor opacification of the left PCA at P3-P4 level.
No intra- or extra-axial collection or hemorrhage. No focal abnormality. Grey-white differentiation is preserved elsewhere. Ventricular size, sulcal pattern, and basal cisterns all appear normal. No bony abnormality.
Lacunar infarction of the head of the caudate nucleus.
A dominant left vertebral artery with a hypoplastic right vertebral artery ending mainly in a posterior inferior cerebellar artery (PICA).
Fetal origin of the right posterior cerebral artery.
Ischemic lesion within left occipital lobe with a corresponding hyperintense signal on FLAIR images (late hyperacute stroke).
Flair hyperintensities within the subcortical and periventricular white matter, in keeping with a chronic cerebral small vessel disease.
Poor opacification of the distal left PCA compared to the right side.
Fetal origin of the right posterior cerebral artery.
Case Discussion
The mechanism of vessel obstruction, in this case, is probably due to embolism, since this patient has a history of atrial fibrillation and is under anticoagulant therapy.
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