A Rare Presentation of Posterior Cerebral Artery Stroke With Monocular Hemianopia After Diesel Exposure

Acute ischemic stroke of the posterior cerebral artery (PCA) presents with variable symptoms that may initially make it challenging to diagnose. Common etiologies of PCA stroke include large and small artery disease, atherosclerosis, and cardioembolism. We present a 69-year-old male, initially diagnosed with sinusitis at an urgent care facility, who presented with worsening headache and peripheral vision loss following exposure to diesel vapor and exhaust. Physical examination revealed a right monocular temporal hemianopia and subsequent imaging showed infarction of the left occipital lobe. Due to the length of time between the onset of the infarct and medical treatment, angiography and physical intervention were not indicated and management was done medically. This case presents a unique exposure prior to the development of a PCA stroke, as well as an atypical visual defect and suggests that physicians should consider neuroimaging in patients with nonspecific neurological findings such as new-onset headache and vision changes.