Acute right homonymous hemianopia
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Wedge shaped loss of grey-white matter differentiation within the left medial occipital lobe is in keeping with an acute left PCA infarct. No intracranial hemorrhage. No significant mass effect.
Periventricular white matter hypoattenuation is most likely in keeping with moderate chronic small vessel ischemia. Ventricular size is normal. Basal cisterns are unremarkable.
Good case of acute PCA infarct causing a typical visual defect for disruption of the optic pathway posterior to the thalami (ie homonymous hemianopia). Chronic microangiopathic changes in this case were due to a long history of vasculopathy and multiple CVA risk factors.