a b s t r a c tStroke occurs due to the interruption of blood flow to the brain and it is divided into ischemic and hemorrhagic. In the ischemic strokes, while the most commonly affected vessel is median cerebral artery (MCA), it is particularly affected bilateral posterior cerebral artery (PCA) is very rare condition. In this study, a case of sudden loss of vision and bilateral occipital infarct associated with bilateral vertebral system pathology and methylene tetrahydrofolate reductase (MTHFR) gene mutation were reported. A 62-year-old man was admitted with sudden loss of vision complaint starting 10 h before applying to emergency department. The patient was oriented and cooperative. On neurological examination, there was complete loss of vision in the right eye and only a response to light in the left eye. On the brain computerized tomography (CT), ischemic lesions were observed in the bilateral occipital areas and on magnetic resonance imaging (MRI), there were foci showing diffusion limitation in cortico-subcortical areas of bilateral parieto-occipital region. On the detailed examination at the clinic, MTHFR (a1298c) gene mutation was detected. Bilateral occipital infarction is rare and its diagnosis can be difficult because of its atypical symptoms. Therefore, occipital infarction should be suspected when the only sign is isolated vision loss in patients with risk factor for thromboembolism in their history and detailed visualneurological examination of these patients should be performed.

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Objective: Emergency physicians, with their life-saving roles in critical diseases' initial evaluation, are essential for patient safety within the health system. The aim of the study is to evaluate whether the practitioners working in the ER and expert physicians (in disciplines other than emergency medicine) consider themselves competent regarding the frequent life-threatening diseases that are encountered and the accuracy of their notions. Material and Methods: A survey of 20 questions was given to ER physicians working in hospitals. Results: Of the physicians that took the survey, 82.7% considered their knowledge regarding the initial treatment of a patient admitted to the ER as sufficient or very sufficient; 65.3% of the physicians stated that four or less symptoms that would raise suspicion in an EKG of patients admitted to the ER with myocardial infarction, while 34.7% stated that there may be five or more symptoms. Additionally, 53.8% of the physicians consider themselves competent/very competent in recognizing bleeding and ischemia in brain tomography. Furthermore, 81.6% of the physicians considered their ability to apply initial treatment to a patient with diabetic ketoacidosis as sufficient or very sufficient, while the percentage of physicians who stated that the fluid deficit of a patient with diabetic ketoacidosis is 5 L or more was 55.4% Conclusion: With this study, we found evidence indicating a serious lack of knowledge among practitioners treating patients in the ER and expert physicians not related to emergency medicine regarding crucial matters related to patients admitted to the ER.

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