The significance of periorbital ecchymosis (‘racoon eyes’) appearing shortly after a neurointerventional procedure may be overlooked, particularly in the setting of intervention distant from the ocular venous drainage system in an otherwise neurologically stable patient. This seemingly innocuous sign may be indicative of subarachnoid hemorrhage from procedure related arterial dissection.

An 82-year-old man on aspirin and clopidogrel underwent elective right middle cerebral artery (distant M1 segment) angioplasty and stent placement for recurrent orthostatic …