Posterior cerebral artery occlusion without hemianopia.

Area of Science:

• Neurology
• Neuroscience
• Vascular Neurology

Background:

• Posterior cerebral artery (PCA) occlusions typically cause visual field defects due to infarction in the occipital lobe.
• Visual field sparing is uncommon in PCA strokes, though it can occur in cases of surgical PCA occlusion.

Observation:

• A 42-year-old male patient presented with ischemic infarction in the left PCA territory.
• Despite the occlusion, the patient exhibited no visual field defects on examination or Goldmann perimetry.
• Arteriography revealed distal PCA filling without collateral flow from the carotid circulation, indicating leptomeningeal anastomoses.

Findings:

• Complete visual field sparing in the presence of PCA occlusion suggests potential collateral circulation via leptomeningeal anastomoses.
• This case demonstrates that PCA infarction can occur without the expected visual field deficits.

Implications:

• Neurological deficits resulting from PCA occlusion should not be dismissed solely based on the absence of visual field defects.
• Relying on visual field assessment alone may lead to underdiagnosis of PCA infarction.
• Further etiological investigations for neurological deficits may be unnecessary if PCA infarction is confirmed despite visual field sparing.