Pupils were 2-3mm and reactive bilaterally with no papillary afferent defect. On examination, he was mildly hypertensive, with otherwise normal vital signs. His home medications included lisinopril, amlodipine, gabapentin and tamsulosin. The patient later admitted to using cocaine within the week prior to presentation and no other illicit drugs. His social history was significant for regular heavy alcohol use, one pack per day smoking history, and occasional cocaine use. The patient’s family history was remarkable for coronary artery disease and diabetes. A thorough review of systems was otherwise negative. He was able to read significantly more fluently when the material was upside-down rather than right-side up. He also complained of a visual phenomenon where everything appeared inverted 180 degrees, as if people were “walking on the ceiling.” His inverted vision significantly affected his ability to ambulate steadily. He had some increased weakness in his right leg. He complained of associated vomiting, inability to sit up straight without support, and had reverted to crawling secondary to unsteadiness when walking. He presented to the emergency department with a one-week history of dizziness, headache, andĭifficulty walking which had been getting progressively worse. The patient is a 57-year-old left-handed African American male with a history of hypertension, cocaine, tobacco and alcohol abuse, and previous left basal ganglia lacune five years ago with no residual deficits. Keywords: Posterior Circulation Stroke Presentation Occipital lobe Vertigo Syndrome Reinforces Cerebellum Phenomenon Pathophysiology Disability Disorder Hallucinations Patients Seldom Dizziness Headache Tamsulosin It reinforces the few cases reported and adds credence to this location, the cerebellum, which may help define this poorly understood phenomenon. This case highlights the importance of recognizing that this spatial perception disorder could be part of a vertebrobasilar syndrome. Stroke is a leading cause of death and disability especially when involving the posterior circulation. He suffered a stroke to the PICA distribution of the left cerebellum.Ĭonclusion: There are few case reports of inverted vision with ischemic stroke and the pathophysiology is not well understood. Inverted vision, or upside-down vision, is a very rare presentation of stroke.Ĭase Presentation:We report a case of a 57-year-old African-American male who presented with one week of vertigo and inverted vision after inhaling cocaine. These deficits are almost exclusively due to cortical lesions in the occipital lobe or its border zones. Other deficits to name a few include visual agnosias, achromatopsia, illusions and hallucinations. Visual field defects are common and are a component of the NIHSS. Introduction:Disorders of visual perception are well known to occur in posterior circulation strokes.

Left pica stroke