Transient Monocular Vision Loss TMVL

A 64-year-old man presented to an emergency department because of 20 minutes of a visual disturbance in his right eye that developed that morning as he was sitting and speaking with a friend. He described a graying of my vision that started superiorly in the right eye and descended over several seconds to the horizontal meridian. He had difficulty distinguishing his friend's features from the neck up (or any other details in his superior field for that matter). He closed one eye at a time, and...

Lobar Hemorrhage in Cerebral Amyloid Angiopathy

An 82-year-old man is brought to the emergency room by his family because of a severe headache and complaint that he cannot see to the right. He was reported to be well early that morning. After breakfast, he developed an occipital headache. He noticed he could not see the right-hand side of the newspaper he was reading so he called to his wife. Previous medical history was significant for hypertension, atherosclerotic cardiovascular disease, a left hemiparesis secondary to a right...

What do you do now

This patient has vascular dementia due to chronic microvascular disease. This entity, described originally by Otto Binswanger, a German pathologist, is characterized pathologically by multiple lacunar infarcts and confluent areas of soft, puckered, and granular tissue in the cerebral and cerebellar white matter. The white matter lesions are patchy and predominantly affect the periventricular white matter, especially anteriorly and close to the surface of the ventricles. The volume of white...

Arterial Dolichoectasia with Pontine Infarction

A 75-year-old man presented to an emergency department at noon reporting right-sided hemiparesis and dysarthria. One week before, he had a transient episode of right face, arm, and leg weakness, and dysarthria lasting thirty minutes with complete resolution. On the day of presentation, he awoke at 7 AM with similar symptoms but they persisted. For about a year he had had daily, brief, left-sided lancinating facial pains that were excruciating. This facial pain was triggered and exacerbated by...