Altitudinal, upper or usually lower hemianopia may be mostly uni- but also bilateral and spare the horizontal meridian as well as macular vision. An 81-year-old man suddenly developed complete bilateral inferior altitudinal hemianopia, sparing the macular area on the one side but involving macular vision on the other.The ophthalmological examination revealed further nothing abnormal: open angle glaucomatous disease was ruled out. A repeat CT-scan of the brain, 12 days after onset of the neuro-ophthalmological condition, showed in addition a bilateral cortical occipital infarction. On the CT-scan, before the onset of the latter condition, a hematoma in the right thalamus, with hemorrhage into the right frontal conus and third ventricle had been diagnosed in a patient with only mild left hemiparesis.