Ischemia is a rare cause of the optic chiasmal syndrome and is ?sometimes hard to define. The present report describes a 73 year-old male with abruptly developed ?visual field defect involving bitemporal hemianopsia and inferior binasal quadrantanopsia. The MRI study ?revealed focal anterior hypothalarnic atrophy which might be due to focal infarction. These findings ?are suggesting common blood supply of superior chiasmal circulation and anterior inferior hypothalamus.?