An 18-year old woman presented with an 8-day history of sharp, left-sided headaches. Visual acuity was 20/20 bilaterally. A,B, She was noted to be losing letters to the right, and bilateral 10-2 programs demonstrated a tiny 1 degree homoymous scotoma just below and to the right of fixation in both eyes. C, Her angiogram revealed an arteriovenous malformation involving the occipital tip. (arrow)