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Internal Medicine

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A 69 year old female with a past medical history of hypertension, presents to the ED today at 5pm with right eye vision loss that started the day before at 8pm.


Her son was at bedside who stated that her vision loss progressively worsened since last evening and now she cannot see "some things from her right eye".


Patient denied having any fevers, chills, slurred speech, N/V, dizziness, vertigo, chest pain, palpitations, abdominal pain, paresthesias, urgency urination, urinary incontinence, constipation, diarrhea, weakness in any limbs, recent travel history or sick contacts.

She does not take any medications at home. She has not seen a PCP in 4 years.

Vitals on arrival:

BP 190/96 mmHg

HR 88

RR 16

SpO2 98% on room air

Temp 36.4 C


BMI 20.2


Physical examination: patient is A&O X3, eye/visual field exam consistent with right sided homonymous hemianopia. Otherwise, exam is unremarkable.

Labs are WNL.

HS Troponin 4 --> 5


MRI of the brain attached below.


What's your diagnosis and further treatment plan?




N G
Mazen Kherallah
Ayham Alagha
M B

This patient had an acute left temporo-occipital lobe infarct. Code stroke was called on initial presentation. CTA head and neck showed severe stenosis/near complete occlusion of the left PCA at the P2 level. All the stroke work up was done and the patient was discharged to SAR and now has a PCP and goes to the cardio-neuro clinic.

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