Palinopsia as a Rare Presenting Symptom of Occipital Stroke “Case Report”

Abstract

Palinopsia is the recurrence or persistence of visual images after cessation of the stimulus. Palinopsia has been associated with a wide variety of etiologies and mechanisms such as drug induced, seizures, migraine, psychiatric conditions, head trauma and structural lesions in the brain. We report a case of occipital stroke who presented with oscillating palinopsia. Sudden-onset palinopsia is a very rare symptom of stroke, but it must be recognized early as it is a highly time dependent, and potentially treatable condition. A 57-year-old woman with a history of poorly controlled type 2 diabetes, hyperlipidemia, and hypertension presented with sudden onset right sided palinopsia with images of her face and right forearm with hand, occurring several times in a day, lasting for a few minutes each time, and appearing in the same location each time. There are few case reports in literature secondary to stroke and what makes it interesting also is that she reported persistence of image even when her eyes are closed. Moreover, the sudden onset is not common in literature. The Magnetic Resonance Imaging (MRI) of the brain showed evidence of left Posterior Cerebral Artery (PCA) territorial (Fusiform gyrus) subacute ischemic infarction. Visual field assessment showed a right homonymous hemianopia. She was treated with aspirin and clopidogrel. The frequency and intensity of palinopsia reduced subsequently. The face image disappeared in the first week while the forearm image disintegrated gradually over the next few weeks. Palinopsia may be a rare presenting symptom of stroke. It is important for the clinician or emergency room doctors to be alert to the possibility of undiagnosed structural neurological lesions like occipital stroke and differentiate it from non-organic causes, as prompt management may reduce the risk of visual or motor disability.