Transient visual blurring, retro-orbital pain and repetitive involuntary movements in unilateral carotid artery occlusion

An 83-year-old man presented with episodes of right sided retro-orbital pain, visual disturbance, involuntary jerks of his left arm and less frequently his left leg. The symptoms could be triggered by exercise, heat or cough. EEG recordings revealed no epileptic discharges. Duplex ultrasonography showed an occlusion of the right internal carotid artery. Blood flow velocity in the right middle cerebral artery was reduced and vasomotor reactivity to hypercapnia was absent. Reduction of his antihypertensive medication rendered the patient asymptomatic. The combination of transient visual blurring, retro-orbital pain and contralateral limb shaking can be an unusual manifestation of carotid occlusive disease. In such a case, the symptoms may be managed successfully by the elevation of blood pressure.