Sequential appearance and disappearance of hemianopia, palinopsia and metamorphopsia: A case report and literature review

We report a case with a sequential appearance and disappearance of homonymous hemianopsia, palinopsia and metamorphopsia in the defective visual field within two days. She had a stroke nine months ago and recovered completely. During that episode, dizziness and unsteadiness happened suddenly and was followed by above-mentioned visual symptoms. Brain image and blood perfusion studies showed an old right occipital lesion with hemodynamic changes. Electroencephalograms performed immediately just after the disappearance of all the above-mentioned symptoms subsided and four months later showed similar findings, some isolated independent sharp waves over bilateral temporal areas, with right posterior extension. These were independent of her visual symptoms. The pathophysiologies of our case could be a sequential hemodynamic change in the right occipital area, from hypoperfusion to transient hyperperfusion and finally to normal perfusion. Potential mechanisms are discussed with literature review.