# New-Onset Occipital Lobe Epilepsy in an Elderly Patient With Visual Hallucinations and Hemianopia

## TL;DR

An elderly man with visual hallucinations and hemianopia was diagnosed with occipital lobe epilepsy, highlighting the need for careful evaluation to avoid misdiagnosis.

## Contribution

This case study emphasizes the diagnostic challenges of OLE and its distinction from similar neurological conditions.

## Key findings

- The patient exhibited visual hallucinations and hemianopia consistent with occipital lobe epilepsy.
- MRI and MRA ruled out stroke but showed cerebral atrophy and microvascular changes.
- Treatment with levetiracetam and lorazepam reduced seizure frequency.

## Abstract

Occipital lobe epilepsies (OLEs) are a subset of epileptic disorders manifesting predominantly with visual and oculomotor abnormalities that are often misdiagnosed due to similarities with migraines with visual aura and other central nervous system (CNS) pathologies. This case study describes an 88-year-old male with a three-week history of intermittent kaleidoscopic visual phenomena, accompanied by blurring of vision and altered level of consciousness. Neurological examination revealed right homonymous hemianopsia and focal neurological deficits, including forced right gaze preference and nystagmus. Diagnostic modalities, MRI and MRA, ruled out ischemic stroke but indicated mild to moderate cerebral atrophy and chronic microvascular ischemic changes. The patient exhibited a seizure episode characterized by right-sided gaze preference and altered consciousness. Postictally, transient right homonymous hemianopsia was observed, consistent with Todd's phenomenon. Treatment with intravenous levetiracetam and lorazepam led to a reduction in seizure frequency. This case highlights the importance of comprehensive evaluation in distinguishing OLEs from other conditions with similar visual presentations like migraine with aura or occipital lobe stroke being more predominant.