A 65-year-old man with hypertension and hypercholesterolaemia is admitted with right sided weakness

A 65-year-old man with hypertension and hypercholesterolaemia is admitted with right sided weakness. He has marked receptive dysphasia.
Examination reveals right sided facial weakness as well as right-sided hemiparesis. Sensation on the right side of the body is also impaired.
The presence of which additional finding would suggest a diagnosis of a left total anterior circulation infarct (L
TACI) rather than a left partial anterior circulation infarct (L PACI)?

A Bitemporal hemianopia
B Right homonomous hemianopia Correct
C Left sided visual neglect
D Left homonomous hemianopia
E Right sided visual neglect

Answer A is incorrect, because a bitemporal hemianopia is caused by a lesion of the optic chiasm.
Answer B is correct because a TACI comprises of all three of the following:

  1. Higher cortical dysfunction which includes visuospatial disturbance (in this case visuspatial neglect),
    dysphasia and/or a decreased level of consciousness
  2. Homonomous hemianopia
  3. Motor and sensory deficits in two or more of the contralateral face/arm/leg.

Answer C is incorrect. Left sided visual neglect may be present in this patient (as part of the higher cortical
dysfunction), but a homonomous hemianopia must be present to fulfil the criteria for a TACI. It is important to
note that a patient may have normal visual fields, but may still have left-sided visual neglect.
Answer D is incorrect because a right TACI would cause a left homonomous hemianopia and not a right
homonomous hemianopia.
Answer E is incorrect because left homonomous hemianopia must be present to fulfil the criteria for a TAC