Test Your Knowledge

Goal: This multiple choice question will test students' knowledge regarding the neuro-ophthalmic findings that are associated with occipital epilepsy.

Test Your Knowledge! Ritu Sampige, BS Baylor College of Medicine, School of Medicine, Houston, TX, USA Courtesy: Ritu Sampige NOVEL: Test Your Knowledge Collection A middle-aged adult male with a past medical history of diabetes mellitus presents with the following: homonymous hemianopsia, concurrent bilateral visual hallucinations (colored circles), eye deviation, and lid fluttering for minutes. Other components of the eye exam are normal. Which of the following conditions is the patient most likely presenting with? A. Internuclear ophthalmoplegia B. Non-arteritic anterior ischemic optic neuropathy C. Occipital epilepsy D. Pituitary adenoma Image source: Indicated in the next slide to ensure that the correct answer is not prematurely revealed in this slide. Occipital Epilepsy Correct Answer: C. Occipital epilepsy • While patients with epilepsy do not frequently present to the neuro-ophthalmology clinic, patients with occipital epilepsy, specifically, may present due to neuro-ophthalmic findings. • Neuro-ophthalmic findings include visual hallucinations (small, geometric, circular colors), eye deviation, and lid fluttering. Visual field testing should be conducted to evaluate for the presence of homonymous hemianopsia, which would indicate signs of a subsequent structural deficit. • Occipital epilepsy may occur in adult or pediatric patients. Benign occipital epilepsy often begins in childhood, and pediatric patients may present with autonomic signs as well. • In the case vignette, the next steps would be to conduct an MRI and an EEG. • INO (answer A) is evidenced by the lack of conjugate lateral gaze due to impairment of adduction ipsilaterally and the presence of contralateral abducting nystagmus. NAION (answer B) typically occurs in older adults and presents with acute, monocular, and painless vision loss. Pituitary adenoma (answer D) typically presents with bitemporal hemianopsia. These findings were not presented in the case vignette. Image source: Engez D, Yılmaz NH, Ekmekçi EN, Sert İ, Koc G. Occipital Seizures and Persistent Homonymous Hemianopia (HH) With MRI Subcortical T2 Hypointensity in a Newly Diagnosed Diabetic Patient. Cureus. 2022;14(6). Available at https://doi.org/10.7759%2Fcureus.25648. Accessed 30 June 2024. Lee AG, Janwadkar A. Occipital Seizures. NOVEL - Andrew Lee Collection. 2021. Video. Available at https://collections.lib.utah.edu/ark:/87278/s6z9592t. Accessed 30 June 2024.