A 68-year-old left-handed man was admitted with sudden left-sided weakness. He was an ex-smoker but did not have any other vascular risk factors. He was dysphasic, had left-sided neglect and a left hemiparesis. In addition, he had a right relative afferent pupillary defect but fundal examination through undilated pupils did not reveal any obvious pathology. A CT scan was unremarkable. He presented too late to receive thrombolysis on licence. Subsequent MR brain imaging and MR angiography confirmed an acute right middle cerebral artery infarct, along with an occluded right common carotid artery and 50% stenosis of the left common carotid artery. By day 10, he had improved enough to be seen in the Eye …