A case of paroxysmal homonymous hemianopsia: Uncommon presentation of nonconvulsive status epilepticus

• Main Authors: Yoshiyasu Matsumoto, MD, Yosuke Akamatsu, MD, Yasushi Ogasawara, MD, Kenta Aso, MD, Sotaro Oshida, MD, Hiroshi Kashimura, MD
• Format: Article
• Language: English
• Published: Elsevier 2020-06-01
• Series: Radiology Case Reports
• Subjects: ASL; Simple partial epilepsy; EEG; Homonymous hemianopsia; Nonconvulsive status epilepticus
• Online Access: http://www.sciencedirect.com/science/article/pii/S1930043320300856
• ISSN: 1930-0433

Paroxysmal homonymous hemianopsia (HH) is uncommon presentation of epilepsy. We demonstrate a rare case of paroxysmal HH that was diagnosed by magnetic resonance (MR) arterial spin-labeling (ASL). A 82-year-old woman presented with abrupt onset of isolated visual field abnormality without convulsive epilepsy at 16 days after a traumatic head injury. Diffusion weighted and MR-ASL obtained on admission revealed hyperintensity and hyperperfusion in the right temporo-occipital cortex. Nonconvulsive status epilepticus was suspected. The patient was treated with oral levetiracetam and the symptoms resolved in 3 days. Paroxysmal HH should be considered in patients who present with simple partial epilepsy, and MR-ASL imaging may assist in the differential diagnosis of these patients.