March 3, 2026Open Access

Complex Visual Hallucinations in Post-stroke Epilepsy: A Case Report and Literature Review

Key Points

Complex visual hallucinations were observed in a patient with post-stroke epilepsy, resolving after treatment.
Electroencephalography showed epileptic discharges in the right posterior temporal and parietal regions.
Management involved levetiracetam for immediate relief and zonisamide for ongoing maintenance, ensuring stability.
Recognition of complex visual hallucinations may enhance treatment strategies and prevent misdiagnoses in post-stroke epilepsy.

Abstract

We herein report an 82-year-old man with post-stroke epilepsy (PSE) who presented with persistent complex visual hallucinations (CVH) involving past episodic scenes. Electroencephalography revealed epileptic discharges in the right posterior temporal and parietal regions. The symptoms resolved with levetiracetam and were maintained with zonisamide. A literature review suggested that CVH may occur when epileptic activity spreads to non-dominant temporal or parietal regions. In conclusion, CVH may reflect visual memory and retention and can be accompanied by psychiatric symptoms. Improved recognition of CVH as a manifestation of PSE may help avoid misdiagnoses and lead to appropriate treatment.

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Discussion

Journals

Internal Medicine

Institutions

Saitama Medical University

References and Citations

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