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Visual hallucinations and palinopsia due to an occipital lobe tuberculoma
  1. D J WERRING,
  2. C D MARSDEN
  1. Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
  1. Dr DJ Werring, NMR Research Unit, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. Telephone 0044 171 837 3611 extention 4307; fax 0044 171 278 5616; emaild.werring{at}ion.ucl.ac.uk.

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A 35 year old man noted a “starburst” in his right visual field (see his own illustration, figure, left) and a posterior headache. These symptoms resolved but returned intermittently over the next 2 months. He also described the persistence of images of objects seen in his right hemifield. Examination disclosed no abnormality of pupillary responses or of formally performed visual fields. Contrast enhanced MRI (figure, right) disclosed a ring enhancing lesion in the left occipital lobe, which was shown to contain tuberculous granulomata by biopsy. He responded to standard antituberculous therapy, and remains symptom free 2 years later. The coloured visual symptoms, which were probably due to focal cortical irritation from the tuberculoma, may have been mistaken clinically for migraine; however, perseveration of images (palinopsia) is highly suggestive of a structural occipitoparietal lesion.

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