Objective:

To describe a rare case of acute bilateral cerebral dyschromatopsia resulting from sequential and temporally separated unilateral temporo-occipital strokes.

Background:

Cerebral dyschromatopsia, a loss or alteration of color vision due to cortical damage, is a rare phenomenon typically resulting from bilateral occipitotemporal injury, most often secondary to posterior circulation strokes. Isolated dyschromatopsia from unilateral lesions is underrecognized, and cases involving bilateral damage from temporally distinct events are even more uncommon.

Design/Methods:

NA

Results:

A 70-year-old male with a history of cardiovascular disease and prior right temporo-occipital stroke presented with acute-onset bilateral color vision loss. The standard ophthalmologic exam, including visual acuity, funduscopy, and tonometry was normal. He was referred for further neurological evaluation. In the emergency department, his only complaint was bilateral loss of color perception. Neurologic exam revealed an unrecognized left superior quadrantanopia. NIHSS was 1. MRI demonstrated chronic right temporo-occipital encephalomalacia and acute infarction in the left temporo-occipital lobe. CTA revealed moderate-to-severe stenosis of the distal left P3 segment and chronic occlusion of the right P3 segment. He started dual antiplatelet therapy and a statin. TTE with bubble study and stroke labs were obtained. He was discharged the following day with mild symptom improvement and advised to follow up in the stroke clinic.

Conclusions:

This case highlights a rare presentation of bilateral dyschromatopsia due to the combined effects of two spatially and temporally distinct strokes. The patient was unaware of prior visual field deficits, likely due to anosognosia. While rare, dyschromatopsia should prompt evaluation for bilateral posterior cortical injury. This case underscores the importance of recognizing subtle visual complaints as possible indicators of posterior circulation stroke.