This case illustrates acute bilateral PCA infarction in a known hypertensive patient who presented with a sudden loss of consciousness. MRI also shows an incidental finding of a large olfactory groove meningioma. Prior to the presentation, the patient had no symptoms of an intracranial space-occupying lesion. Meningiomas may be found incidentally and entirely asymptomatic 1.Though larger tumors present with symptoms of SOL such as headache, paresis, or change in mental status.
Mass effect from the large meningioma may be the possible cause of the bilateral PCA territory infarction in this patient. The PCAs arise below the tent and have to get above it to get to the occipital lobes, so they get pinched against it and get occluded.