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Abstract Details

Seeing the Unseen: Junctional Scotoma as a Neuro-ophthalmic Red Flag
Neuro-ophthalmology/Neuro-otology
P4 - Poster Session 4 (8:00 AM-9:00 AM)
17-013
To describe a rare case of carotid dissection manifesting as junctional scotoma, emphasizing the role of neuro-ophthalmologic evaluation in localization and guiding timely, life-saving management.
Junctional scotomas, though rare, are classic visual field defects enabling precise localization to the optic chiasm and its adjacent vascular structures.
Not applicable 

A 51-year-old man with an acute painless right eye vision loss presented to the Emergency Department, where he was diagnosed with a right central retinal artery occlusion. CT angiogram revealed a right internal carotid artery (ICA) dissection with near-complete thrombosis. The vascular team deemed this to be nonsurgical, and aspirin and ticagrelor were initiated.

2 months later, he developed painless superior left eye vision loss and worsening vision in the right. Neuro-ophthalmologic evaluation revealed generalized constriction and a central scotoma for the right eye, along with a superior temporal arcuate scotoma of the left eye. These findings localized to the junction of the right optic nerve and the optic chiasm, confirmed by MRI. Repeat CTA showed right ICA dissection extension to the skull base. Connective tissue disease workup was negative. He was transitioned to apixaban for long-term anticoagulation.
Neuro-ophthalmologic evaluation is essential in critical care and vascular neurology, particularly for identifying life-threatening conditions like carotid artery dissection. A central scotoma in one eye and a superotemporal scotoma in the other is classic for a junctional scotoma, localizing to the optic chiasm and the optic nerve ipsilateral to the central scotoma. Early recognition of these subtle visual field deficits in our case led to prompt diagnosis of the right ICA dissection extension, timely initiation of apixaban, and likely prevention of further neurological deterioration. This highlights the importance of vigilant visual assessment in improving outcomes and reducing disability.
Authors/Disclosures
Saad Umar
PRESENTER 		Mr. Umar has nothing to disclose.
Carlos R. Santos An immediate family member of Mr. Santos has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cochrane. An immediate family member of Mr. Santos has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Giarmarco, Mullins & Horton PC. The institution of an immediate family member of Mr. Santos has received research support from Saint Mary's Foundation. An immediate family member of Mr. Santos has received research support from 好色先生.
Jason T. Schick, DO (Trinity Health Grand Rapids) Dr. Schick has nothing to disclose.
Muhammad Farooq, MD (Neuroscience Program,Saint Mary'S Health) Dr. Farooq has nothing to disclose.
Aileen Antonio, MD, FAAN (Trinity Health Saint Mary's Hauenstein Neurosciences) Dr. Antonio has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cochrane. An immediate family member of Dr. Antonio has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Giamarco, Mullins & Horton PC. The institution of Dr. Antonio has received research support from Saint Mary's Foundation. Dr. Antonio has received research support from 好色先生.
Jose R. Santos, MD (Trinity Health Saint Mary's) An immediate family member of Dr. Santos has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cochrane. Dr. Santos has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Giarmarco, Mullins & Horton PC. Dr. Santos has or had stock in Gilead Sciences.Dr. Santos has or had stock in Novocure.Dr. Santos has or had stock in Shockwave Medical.Dr. Santos has or had stock in Teva. An immediate family member of Dr. Santos has received research support from 好色先生. The institution of an immediate family member of Dr. Santos has received research support from Trinity Health Saint Mary's Foundation. An immediate family member of Dr. Santos has a non-compensated relationship as a Delegate with AAN Neurology on the Hill that is relevant to AAN interests or activities. An immediate family member of Dr. Santos has a non-compensated relationship as a Participant with AAN Palatucci Advocacy Leadership Forum that is relevant to AAN interests or activities. An immediate family member of Dr. Santos has a non-compensated relationship as a Scholar with AAN Health Equity Symposium Scholarship that is relevant to AAN interests or activities. An immediate family member of Dr. Santos has a non-compensated relationship as a Participant with AAN Emerging Leaders Program that is relevant to AAN interests or activities.