OUTCOME: Diagnosis of exclusion
Ms. G’s visual disturbance resembles vitreous detachment or classic migraine; however, the onset is not sudden, her funduscopic exam is normal, and she has no discrete episodes with concomitant headache. Ms. G’s improvement with topiramate is inconsistent with an ophthalmic origin because such photopsia should not improve with medication. It is consistent with recurrent seizures or status epilepticus of the occipital cortex; however, she did not experience multiple discrete episodes a day or generalized seizures experienced by most occipital seizure patients, and her EEG and clinical history are not consistent with seizures. Because we cannot rule out occipital lobe epilepsy, we refer Ms. G for repeat EEG and routine ophthalmologic exam, both of which are normal.
Perceptual disturbances are common in schizoaffective disorder and schizophrenia,13-15 which we consider the most likely etiology of Ms. G’s photopsia, given her normal neurologic and ophthalmologic examinations. We switch her from aripiprazole to ziprasidone, 40 mg/d, discontinue phentermine, and taper and discontinue oxcarbazepine.
Related resources
- Ophthalmology Web. www.ophthalmologyweb.com.
- Aleman A, Larøi F. Hallucinations: the science of idiosyncratic perception. Washington, DC: American Psychological Association; 2008.
Drug Brand Names
- Aripiprazole • Abilify
- Clomiphene • Clomid, Serophene
- Digoxin • Lanoxin
- Nizatidine • Axid
- Olanzapine • Zyprexa
- Oxcarbazepine • Trileptal
- Paclitaxel • Onxol, Taxol
- Phentermine • Adipex-P, Inoamin
- Sertraline • Zoloft
- Topiramate • Topamax
- Ziprasidone • Geodon
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.