Visual hallucinations. More than just a psychiatric problem. (P1-9.011)

Abstract

<h3>Objective:</h3> Visual epileptic seizures and status epilepticus amauroticus have been well defined in the literature but remain underdiagnosed or misdiagnosed due to lack of awareness. <h3>Background:</h3> Visual hallucinations are commonly encountered by neurologists and non-neurologists on a daily basis. They however, are not thought of as seizures by most of physicians and therefore lead to a delay in diagnosis and treatment. Due to this, unnecessary treatment trials, consults to other specialties and admission to psychiatry units are not uncommon. This not only leads to iatrogenic side effects but also leads to increase in health care costs. We present such a case of new onset focal occipital seizures that led to status epilepticus amauroticus. <h3>Design/Methods:</h3> Reviewed detailed medical history and physical examination along with diagnostic tests that include EEG, MRI of brain, and Lumbar puncture. <h3>Results:</h3> Our 82-year-old adult reported persistent blind spot along with hemianopia that presented itself after a traumatic brain injury. He reported intermittent flashing lights in the center of his vision that were green, red, and orange in color lasting for seconds to hours over the past month. Baseline EEG captured 2 such episodes lasting for 1 minute each which were consistent with focal right occipital seizures. MRI of brain showed subtle leptomeningeal enhancement around the right medial occipital lobe. No restricted diffusion was noticed. Two Lumber punctures performed 3 days apart failed to show any abnormality. After starting Keppra photopsias resolved. His visual deficits also improved significantly with the starting of Keppra however, these took few months to resolve completely. Patient at the discharge was diagnosed with new onset focal seizures vs status epilepticus amauroticus. Follow-up magnetic resonance imaging and electroencephalogram demonstrated complete or near-complete resolution of associated abnormalities. <h3>Conclusions:</h3> Increase awareness is essential in timely mannered diagnosis and treatment is essential with visual epileptic seizures. <b>Disclosure:</b> Dr. Bhatti has nothing to disclose.