Case presentation

A man in his 70s developed a sudden onset of confusion and visual disturbance 5 days after a left carotid endarterectomy. He had a history of hypertension, dyslipidaemia, right-sided central retinal artery occlusion with a previously performed right carotid endarterectomy, and coronary artery disease. On examination, his blood pressure was markedly elevated. His right eye was blind at baseline but there was also a left nasal visual field deficit, but no other focal neurological signs. CT scan of head found no acute abnormality, such as ischaemic or haemorrhagic stroke. CT angiogram of the head and neck showed no acute large intracranial arterial occlusion but showed a high-grade stenosis affecting the right common carotid artery and postsurgical changes in the left common carotid artery. …