A 45-year-old man was sitting at his desk when he suddenly became disoriented, followed by inability to talk, right-sided weakness, and a scotoma on the visual field of his left eye. Visual acuity was 20/20-1 OD and 20/70-3 OS; unchanged with pinhole testing. There was a partial right inferior homonymous hemianopia. In addition, in both eyes he had paracentral scotomas on the left field. Pupils were 7 mm in diameter with normal reactivity. There was no relative afferent pupillary defect (RAPD).

Our patient had a spontaneous left extracranial internal carotid artery (ICA) dissection resulting in left hemispheric and left retinal ischemia. He was treated with intra-arterial thrombolysis.