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J Neurol Neurosurg Psychiatry 75:1623-1625 doi:10.1136/jnnp.2003.031229
  • Short report

Visual disturbances representing occipital lobe epilepsy in patients with cerebral calcifications and coeliac disease: a case series

  1. M Pfaender1,
  2. W J D’Souza1,
  3. N Trost3,
  4. L Litewka2,
  5. M Paine4,
  6. M Cook2
  1. 1Department of Neuroscience, Alfred Hospital, Melbourne, Victoria, Australia
  2. 2Department of Neurology, St Vincent’s Hospital, Melbourne, Victoria, Australia
  3. 3Department of Radiology, St Vincent’s Hospital
  4. 4The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  1. Correspondence to:
 Dr M M Pfaender
 Department of Neuroscience, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; mona_pfaenderhotmail.com
  • Received 29 October 2003
  • Accepted 21 January 2004
  • Revised 7 January 2004

Abstract

Paroxysmal visual manifestations may represent epileptic seizures arising from the occipital lobe. In coeliac disease (CD) bilateral occipital calcifications and seizure semiology consistent with an occipital origin have been described, primarily in Mediterranean countries. By reporting three adult patients from an Australian outpatient clinic with visual disturbances, occipital cerebral calcifications, and CD, this study seeks to emphasise that CD should be considered even when patients of non-Mediterranean origin present with these symptoms. Seizure types included simple partial, complex–partial, and secondarily generalised seizures. The seizure semiology consisted of visual disturbances such as: blurred vision, loss of focus, seeing coloured dots, and brief stereotyped complex visual hallucinations like seeing unfamiliar faces or scenes. Symptoms of malabsorption were not always present. Neurological examination was unremarkable in two patients, impaired dexterity and mild hemiatrophy on the left was noted in one. Routine electroencephalography was unremarkable. In all cases, computed tomography demonstrated bilateral cortical calcification of the occipital-parietal regions. Magnetic resonance imaging showed no additional lesion. All patients had biopsy confirmed CD. Seizure control improved after treatment with gluten free diet and anticonvulsants. This report illustrates the association between seizures of occipital origin, cerebral calcifications, and CD even in patients not of Mediterranean origin.

Footnotes

  • Competing interest: none declared

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