Cortical blindness, a consequence of bilateral occipital lobe lesions, typically manifests with partial or complete visual loss. It is often associated with the intriguing phenomenon of visual anosognosia, wherein patients paradoxically deny their profound visual loss, which would often lead to confabulation. This constellation of clinical findings points to Anton’s Syndrome. Bilateral occipital infarcts are the most common cause of cortical blindness, and the cooccurrence of visual anosognosia is frequently reported in these cases. We present a unique case of a 65-year-old right- handed Filipino male who experienced sudden, acute cortical blindness resulting from simultaneous bilateral occipital infarcts of likely cardioembolic origin secondary to atrial fibrillation. Despite the cortical blindness, the patient explicitly acknowledged his blindness and was not demonstrating signs of denial or confabulation. The patient’s neurological examination was otherwise notable only for the visual impairment, without other focal deficits. This clinical presentation stands in contrast to the typical features of Anton's syndrome. Cranial magnetic resonance imaging revealed acute infarcts in both occipital lobes and the right pons. This unusual presentation underscores the heterogeneity in the clinical expression of posterior circulation strokes. This case contributes valuable insights into the complex neural pathways involved between visual information processing, its awareness, and speech production following bilateral occipital infarction. This is the Philippines’ unprecedented case of bilateral visual loss after simultaneous acute bilateral occipital infarcts occurring without accompanying visual anosognosia.

Human ; Male ; Aged: 65-79 Yrs Old ; Cardioembolic Stroke ; Embolic Stroke ; Stroke

Cortical blindness, a consequence of bilateral occipital lobe lesions, typically manifests with partial or complete visual loss. It is often associated with the intriguing phenomenon of visual anosognosia, wherein patients paradoxically deny their profound visual loss, which would often lead to confabulation. This constellation of clinical findings points to Anton’s Syndrome. Bilateral occipital infarcts are the most common cause of cortical blindness, and the cooccurrence of visual anosognosia is frequently reported in these cases. We present a unique case of a 65-year-old right- handed Filipino male who experienced sudden, acute cortical blindness resulting from simultaneous bilateral occipital infarcts of likely cardioembolic origin secondary to atrial fibrillation. Despite the cortical blindness, the patient explicitly acknowledged his blindness and was not demonstrating signs of denial or confabulation. The patient’s neurological examination was otherwise notable only for the visual impairment, without other focal deficits. This clinical presentation stands in contrast to the typical features of Anton's syndrome. Cranial magnetic resonance imaging revealed acute infarcts in both occipital lobes and the right pons. This unusual presentation underscores the heterogeneity in the clinical expression of posterior circulation strokes. This case contributes valuable insights into the complex neural pathways involved between visual information processing, its awareness, and speech production following bilateral occipital infarction. This is the Philippines’ unprecedented case of bilateral visual loss after simultaneous acute bilateral occipital infarcts occurring without accompanying visual anosognosia.

Human ; Male ; Aged: 65-79 Yrs Old ; Cardioembolic Stroke ; Embolic Stroke ; Stroke

Humans ; Embolic Stroke ; Cardiomyopathies ; Stroke ; Atrial Fibrillation ; Risk Factors

Humans ; Embolic Stroke ; Cardiomyopathies ; Stroke ; Atrial Fibrillation ; Risk Factors

BACKGROUND AND OBJECTIVES: Neurologic intolerance (NI) is defined as the occurrence of neurological symptoms during carotid artery stenting (CAS). Because NI is inevitable problem, it may be helpful to anticipate its occurrence. So, we studied factors associated with NI during proximal protected CAS. METHODS: We retrospectively analyzed all consecutive patients underwent proximal protected CAS from August 2012 to January 2017. RESULTS: We included total 123 patients (109 males, 72±8 years old). The total procedure time was 43±12 minutes, and mean occlusion time was 4.8±1.2 minutes. We divided CAS patients into 2 groups according to presence of NI; neurologic tolerance (NT; n=74, 60%) and NI (n=49, 40%) groups. After the univariate analysis, symptomatic carotid artery stenosis (p = 0.003), absence of anterior communicating artery (p = 0.015) and low common carotid artery occlusion pressure (CCAOP, p < 0.001) were associated with NI. After the multivariate analysis, NI was significantly associated with symptomatic carotid artery stenosis (odds ratio [OR], 5.549; p = 0.014) and systolic CCAOP≤42 mmHg (OR, 6.461; p < 0.001). In NI group, 43 patients (88%) recovered right after the balloon deflation and 2 patients were normalized within 2 hours. However, 1 had major stroke and 3 had minor strokes in 4 patients with persistent NI ≥24 hours. CONCLUSIONS: About 40% showed NI during the CAS. Most of them (88%, 43 of 49 patients) recovered after the balloon deflation, but stroke incidence was significantly higher in NI group. Symptomatic carotid artery stenosis and systolic CCAOP ≤42 mmHg were significantly associated with the development of NI during proximal protected CAS.
Arteries ; Carotid Arteries ; Carotid Artery, Common ; Carotid Stenosis ; Embolic Protection Devices ; Humans ; Incidence ; Male ; Multivariate Analysis ; Neurologic Manifestations ; Retrospective Studies ; Stents ; Stroke

OBJECTIVE: The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events. METHODS: A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group. RESULTS: Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS. CONCLUSION: In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.
Carotid Arteries ; Carotid Stenosis ; Embolic Protection Devices ; Humans ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents ; Stroke