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A 66 year old woman developed the abrupt onset of difficulty seeing to the left associated with numbness of the left side.
MRI - Diffusion weighted image - Note the high signal in the distribution of the right posterior cerebral artery. However, looking closely, there is also an infarction in the right thalamus. This is the picture of an embolus in the proximal posterior cerebral artery. The small perforating arteries to the thalamus arise from the proximal posterior cerebral artery. Also note the subtle acute infarction in the left occipital pole. This finding indicates involvement of the left posterior cerebral artery. Putting all of these lesions together, the embolus was likely situated at the top of the basilar and then broke up and propagated into the right posterior cerebral artery proximally.
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