Episodes of complete binocular TVL may represent a TIA that involves the occipital lobes in the distribution of the basilar artery or the posterior cerebral arteries (see Chapter 1); these episodes are particularly common in older patients with vascular risk factors or cardiac anomalies. As opposed to migraine, hemianopic events of ischemic origin are typically sudden in onset and last only a few minutes. There may be an associated headache, especially in the brow contralateral to the hemianopia, but the pain occurs at the time of TVL. Nonophthalmic symptoms of TIAs in the vertebrobasilar system are discussed in Chapter 14.
Patients with suspected occipital TIA must be referred immediately to an emergency department and evaluated by a neurologist.
Lawlor M, Perry R, Hunt BJ, Plant GT. Strokes and vision: the management of ischemic arterial disease affecting the retina and occipital lobe. Surv Ophthalmol. 2015;60(4): 296–309.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.