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Acute Persistent Visual Loss: Occipital Cortex Infarction
What causes it?Thromboembolism in the vertebrobasilar circulation. This is a stroke in the distribution of the posterior cerebral artery. Usually only one hemisphere is infarcted, so that visual loss is restricted to the contralateral hemifield ("homonymous hemianopia"). Rarely the cortex in both hemispheres is infarcted to cause complete cortical blindness.
The eyes show no abnormalities, and the pupils react normally to light. The clinical clue to diagnosis is finding a homonymous hemianopia with confrontation visual field testing
What to do?There is no acute treatment unless neurologic signs are evolving, in which case the patient should be admitted for emergent evaluation for anticoagulation or thrombolysis.
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