Recurrent Young Stroke With Hemianopia.

Homocysteine is a toxic, sulphur-containing intermediate of methionine metabolism. Hyperhomocysteinemia has been proposed as an important risk factor for ischemic stroke. We present the case of a 39-year-old male who sustained a cerebrovascular accident with left hemiparesis two years back; the patient was not compliant with his medications, and now presented with complaints of giddiness, reduced vision, and double vision. Vision disturbances were bilateral, acute in onset, progressive over time, and predominantly affected the peripheral vision. On ophthalmic examination, homonymous hemianopia was noted, and finger counting was absent in both eyes. Confrontation test revealed a bilateral reduced field of vision more so in the left eye. Baseline investigations were unremarkable except for mildly elevated serum. Homocysteine and neuroimaging showed acute infarct with hemorrhagic transformation in the right occipito-parietal region and small acute non-hemorrhagic infarcts in the right thalamus and right side of the splfingerenium of the corpus callosum. Given the visual disturbance, Humphrey visual field (HVF) perimetry was done and it revealed left homonymous congruous hemianopia, likely due to right parietal lobe infarct. The patient had recurrent infarcts previously involving anterior and posterior circulation.