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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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