Woman presents with spontaneous visual field loss

The New England Eye Center was consulted on a 61-year-old woman with a history of recently diagnosed left-sided greater than right-sided internal carotid artery aneurysms when she presented urgently to the Tufts Medical Center Emergency Department with spontaneous inferotemporal visual field loss noticed upon awakening. At the time of consultation, she additionally described a 3- to 4-week history of transient “black spots and flashes” that occurred in both eyes during coughing episodes that lasted roughly 1 minute. Otherwise, she reported neither pain nor diplopia and believed her remaining visual acuity to be at baseline.A CT of the head and MRI/MRA of the head and neck were performed with concern for enlargement of or embolization from the previously identified aneurysms. The imaging showed stability of the lesions bilaterally. Of note, the patient had recently been started on aspirin and clopidogrel after identification of these aneurysms and was fully compliant with this regimen.