Bilateral complete or severe loss of vision. Patients may deny they are blind (Anton syndrome) or may perceive moving targets but not stationary ones in the blind field (Riddoch phenomenon).

Critical

Markedly decreased vision and visual field in both eyes (sometimes no light perception) with normal pupillary responses.

• Most common: Bilateral occipital lobe infarctions.

• Other: Toxic, postpartum (amniotic embolus), posterior reversible encephalopathy syndromes, posterior cortical atrophy.

• Rare: Neoplasm (e.g., metastasis, meningioma), incontinentia pigmenti.

1. Test vision at distance (patients with bilateral occipital lobe infarcts may appear completely blind, but actually have a very small residual visual field). Patients will do much worse with near-card testing than distance if only a small island remains.

2. Complete ocular and neurologic examinations.

3. MRI of the brain.

4. Rule out nonphysiologic visual loss by appropriate testing (see 10.25, Nonphysiologic Visual Loss).

5. Cardiac auscultation and electrocardiography to rule out arrhythmia.

6. Check blood pressure.

7. Consult neurologist or internist for evaluation of stroke risk factors.

1. Patients diagnosed with a stroke within 72 hours of symptom onset are admitted to the hospital for neurologic evaluation and observation.

2. If possible, treat the underlying condition.

3. Arrange for services to help the patient optimize function at home and their surrounding environment.

As per the internist or neurologist.