PCA stroke can cause "prosopagnosia" which is the inability to recognize familiar faces. Caused by bilateral lesions of visual association areas, which are situated in the inferior occipitotemporal cortex (fusiform gyrus). The ability to name parts of the face (e.g., nose, mouth) or identify individuals by other cues (e.g., clothing, voices) is left intact.

Without knowing that, remembering occipital lobe is involved in 'visual stuff' broadly, including image processing and this patient is having issues with understanding images should be enough to get to the answer.

per UWorld Id 2127:

PCA supplies CN III and IV, thalamus, medial temporal lobe, splenium of the corpus callosum, parahippocampal gyrus, fusiform gyrus, and occipital lobe.

Besides the contralateral hemianopia with macular sparing... a PCA stroke can cause contralateral paresthesias and numbness(involvement of lateral thalamus), dyslexia, visual agnosia (impaired visual recognition of objects) and prosopagnosia (inability to recognize faces)

PCA stroke: Visual Agnosia [can see, but not recognize objects] and Hallucinations, Contralateral hemianopia with macular sparing, Alexia without agraphia[if dominant hemispehere involved].

Lesions of the Temporal Lobe:

Superior temporal gyrus: Acoustic agnosia (patient cannot differentiate between sounds) Middle temporal gyrus: Movement agnosia (patient cannot differentiate between the moving and stationary object) Inferior temporal gyrus: supplied by PCA 1. Prosopagnosia (inability to identify the faces) 2. Achromatopsia (loss of color sensation and everything appears gray to them)