Sirs: The symptom of persistent or recurrent images following the removal of the stimulating object is termed palinopsia (Greek; palin = again, opsis = vision) [1]. Like visual-spatial impairment palinopsia has been associated with lesions of the non-dominant occipital lobe [1, 2]. Hallucinations derived from the primary visual cortex (Brodmann area 17) occur as flashes or light spots. In contrast, sensations from the visual association cortex manifest as more detailed objects (area 18) or complex scenic hallucinations (area 19) [2]. The differential diagnoses include occipital lobe epilepsy, visual deprivation hallucinations, basilar migraine, psychotropic substances abuse and various psychiatric conditions. A previously healthy 64-year-old man had two episodes of syncope lasting five to ten seconds without any warning symptoms. The second syncope occurred while the patient was sitting down, talking to a visitor. Thirty minutes later he drove his car through his hometown. Although being familiar with the route, he had a feeling of derealisation and believed that this could not be his normal way. He got lost and had to ask several passersby for help. To his own surprise the journey lasted an hour instead of the usual five minutes. On admission he was conscious and fully orientated. Examination, including a full neurological assessment, was normal. Our patient did not have any psychotic symptoms, but claimed that his sight had become sharper while reading a newspaper in the waiting lounge. ECG, routine laboratory tests, brain CT and EEG during alertness and sleep were within normal limits. A lumbar puncture revealed only slightly increased cerebrospinal fluid albumin (524 mg/l). On the fifth day the patient maintained that he could see in his central vision a cartoon-like bright-colored wasp, which was projected on every object he focused on, e. g. the senior consultant’s nose during the ward round. Our patient had seen a picture of the wasp in the morning newspaper, but it did not disappear for two hours although he never looked at the newspaper again. He was aware that the wasp did not exist in reality. Later in the evening he had four new episodes of syncope and ECG monitoring revealed asystoles lasting up to 25 seconds (Fig. 1). A sick-sinus syndrome was diagnosed and he received a DDR pacemaker. Although free from further episodes of syncope, our patient experienced pseudohallucinations together or without derealisation up to several times per day. These symptoms were sometimes preceded by a rising epigastric sensation. A second interictal EEG with sleep deprivation remained normal. Brain MRI could not be performed because of his pacemaker. We made a clinical diagnosis of focal epilepsy with simple partial seizures and the patient received sodiumvalproate. After a couple of weeks all symptoms had resolved, but he was lost to follow-up. However, five months later, he developed headache, vomiting, lethargy and hemianopsia. CT revealed a glioblastoma multiforme involving the right temporal-occipital lobe (Fig. 2). Although the initial episode of derealisation together with visual-spatial impairment might resemble transitory global amnesia, these symptoms together with palinopsia and the feeling of a sharper sight were most likely due to partial seizures provoked by the developing glioblastoma multiforme in the occipital lobe. With the tumor invading the temporal lobe, features of temporal lobe epilepsy such as epigastric sensations occurred. On the first CT five months earlier, no signs of a tumor were visible, but contrast had not been given. While it is theoretically possible, that the patient suffered from both sick-sinus syndrome and a brain tumor, it is against the clinical rule that one should look for a single diagnosis combining all symptoms. Indeed, cardiac arrhythmias have been recognized as contributing significantly to sudden unexpected deaths in patients with focal epilepsy [3] and prevention by cardiac pacemaker has been advocated in a recent prospective longterm study [4, 5]. This case illustrates that both common symptoms such as cardiac syncope and uncommon ones such as palinopsia can be associated with a glioblastoma multiforme. A high level of suspicion and a thorough follow-up are necessary, since this connection might first become evident many months later.