Traumatic vertebral artery dissection presenting with incomplete congruous homonymous quadrantanopia

Abstract

Background: To describe a rare presentation of vertebral artery dissection (VAD) as a small but congruous incomplete homonymous hemianopia demonstrating use of visual field testing in the diagnosis.

Case presentation: A 30 year old woman had been unwell for 4 months with difficulty focusing, vertigo, dizziness and a feeling of falling to the right. A small but congruous right inferior homonymous quadrantanopia was found on examination leading to further investigation that uncovered a vertebral artery dissection and multiple posterior circulation infarctions including a left occipital stroke matching the field defect.

Conclusions: We describe an atypical case of VAD presenting with a small congruous quadrantanopia. This is a rare but significant condition that predisposes to multiple thromboembolic infarction that may be easily misdiagnosed and a high index of suspicion is required to make the diagnosis.

Figure 1

Automated perimetry with Medmont Central 100 strategy showing a small right inferior quadrantanopia.

Figure 2

Diagnostic imaging results. (A) Magnetic Resonance Imaging Axial T2 FLAIR section showing a left occipital infarct (arrow) and also a right paramedian thalamic infarct (arrowhead). (B) Coronal view of the right vertebral artery on CT angiogram showing thinning of the artery (arrowhead) and shadowing of the dissected section of the vertebral artery (arrows).