Two bounceback cases highlighted the importance of considering occipital stroke and examining for visual field defects
CASE 1
47F HTN/lipid c/o decreased vision left eye
O/E decreased visual field left eye, sent to ophtho
Ophtho found homonymous hemianopsia, send back for CT: occipital infarct
CASE 2
61M HTN/smoke c/o decreased peripheral vision right eye
CT head normal, referred to ophthalmology
ophtho found bilateral visual field defect, sent back
MRI: occipital infarct
LESSON
- Remember your carefully assess visual fields, especially in patients with stroke risk factors. What patients described as “reduced vision in one eye” may actually be reduced visual field loss from an occipital lesion.
- if you’re concerned about occipital stroke don’t be reassured by a normal CT, get an MRI
