EC Ophthalmology

Posterior cerebral artery (PCA) stroke commonly affects the occipital cortex and frequently presents with homonymous visual field defects despite preserved central visual acuity. Because visual symptoms may occur in isolation, diagnosis may be delayed when routine ophthalmic examination is unremarkable. We report the case of a 35-year-old man who presented with sudden visual disturbance and headache caused by a right PCA ischemic stroke. Best-corrected visual acuity, ocular motility, ocular alignment, and fundus examination were normal, whereas automated perimetry demonstrated left homonymous hemianopia with macular sparing. Comprehensive orthoptic assessment revealed preserved central binocular vision, sensory and motor fusion, and stereopsis despite clinically significant peripheral visual field loss, providing functional information beyond routine ophthalmic examination. This case highlights the diagnostic value of comprehensive orthoptic assessment in patients with occipital stroke and demonstrates that pre- served binocular vision and stereopsis should not exclude clinically significant retrochiasmal pathology.

Keywords: Posterior Cerebral Artery Stroke; Homonymous Hemianopia; Macular Sparing; Orthoptic Assessment; Binocular Vision; Neuro-Ophthalmology

1. Benke T., et al. “Lesion topography of posterior cerebral artery infarcts”. Journal of the Neurological Sciences 428 (2021): 117585.
2. Krishan MV., et al. “Occipito-temporal infarction manifesting as isolated visual perceptual abnormalities: a rare case of posterior cerebral artery stroke”. European Journal of Ophthalmology6 (2021): NP190-NP193.
3. Lawlor M., et al. “Strokes and vision: the management of ischemic arterial disease affecting the retina and occipital lobe”. Survey of Ophthalmology 4 (2015): 296-309.
4. Natale N., et al. “A rare presentation of posterior cerebral artery stroke with monocular hemianopia after diesel exposure”. Cureus5 (2021): e14977.
5. Okunlola AI., et al. “Posterior cerebral artery ischemic stroke in a patient with hypoplastic P1 segment of the posterior cerebral artery”. Nigerian Journal of Medicine3 (2020): 520-523.
6. Zhang X., et al. “Homonymous hemianopia in stroke”. American Journal of Ophthalmology6 (2006): 1097-1105.
7. Zhang X., et al. “Homonymous hemianopias: Clinical-anatomic correlations in 904 cases”. Neurology 6 (2006): 906-910.
8. Ntaios G., et al. “Long-term outcome in posterior cerebral artery stroke”. European Journal of Neurology8 (2011): 1074-1080.
9. Dinkin M. “Natural history of stroke-related homonymous hemianopsia”. Neurology Alert8 (2011): 57-60.
10. Rowe FJ., et al. “Vision in stroke cohort: Profile overview of visual impairment”. Brain and Behavior11 (2017): e00771.
11. Rowe FJ., et al. “Developing a stroke-vision care pathway: A consensus study”. Disability and Rehabilitation3 (2022): 487-495.
12. Park K-C., et al. “Executive dysfunction associated with stroke in the posterior cerebral artery territory”. Journal of Clinical Neuroscience2 (2011): 203-208.
13. Sperber C and Karnath H-O. “The anatomy of spatial neglect after posterior cerebral artery stroke”. Brain Communications 2 (2020): fcaa163.