Bilateral visual loss in carotid artery disease

Bilateral, simultaneous visual loss usually indicates vertebral-basilar insufficiency. We report the case of a patient who experienced transient, bilateral, simultaneous, asymmetrical visual loss. Arteriography revealed flow-restrictive lesions in both internal carotid arteries. The most likely cause for this symptom is bilateral ophthalmic artery hypoperfusion distal to high-grade stenotic lesions of the internal carotid arteries.