A case of occipital epilepsy in an elderly woman

A 73-year-old woman experienced stereotype episodes of complex visual hallucinations over five months. Initially, they were rare and consisted of pleasant static pictures emerging from the left visual field, usually lasting 5 to 10 seconds. Subsequently, they became moving, tormenting pictures, recurring several times a day. On admission, neurological examination revealed reduced contact, nystagmus with fast phase to the left and a left homonymous hemianopia. Electroencephalography (EEG) demonstrated recurrent epileptic discharges starting from the right occipital lobe. The EEG showed sporadic occipital epileptiform activity during the attack-free periods. Phenytoin therapy stopped the seizures and normalized the EEG. An ischemic lesion in the right occipital lobe was detected on cerebral magnetic resonance imaging (MRI) with gadolinium. She continued antiepileptic treatment without recurrence of seizures in the following nine months. This observation of vascular damage-related occipital seizures indicates that epilepsy may be the cause of misdiagnosed behavioral and cognitive disturbances in the elderly. Its prompt recognition is important, since treatment may resolve this type of disorder.