Optic Tract Syndrome Due to Carotid Artery Dolichoectasia

This 43-year-old man was referred for evaluation of 6 months of visual loss OU. In retrospect, he had noticed increasing difficulty with his tennis game dating back over 3 years, as balls would pass him unexpectedly when hit to his backhand (left) side. The patient did not think this was progressive. He had no headaches, no evidence of endocrine dysfunction or collagen-vascular disease, and no other past medical history. On examination he refracted to 20/20 OU and got 10/14 American Optical color plates correct in either eye, largely missing left-sided characters. He had a 0.6 log unit afferent pupillary defect, and a dense (no HM) congruous left homonymous hemianopsia sparing the central 2 degrees. ""Bow-tie"" atrophy was present. The rest of the neurologic examination was normal.