Cerebral polyopia and palinopsia in a patient with occipital lobe epilepsy

Polyopia is the visual perception of multiple images even after removal of an object from the visual field. The appearance of many of the same images while watching a single object is called palinopsia, which is a phenomenon distinct from polyopia. Different types of these phenomena have been ascribed to latency of perseveration, but direct evidence is lacking. We describe a patient with occipital lobe epilepsy who presented with both polyopia and palinopsia. We found that visual perseveration was related to the extent of movement of the original object and that the shape of the object changed in response to stimulation with another object. Palinopsia after the visual stimulus can be superimposed on the background picture, leading to polyopia. That polyopia and palinopsia are distinct phenomena is correct, but they seemed to be related. Both phenomena occurred in the same patient and share an epileptic mechanism. In our patient, visual perseveration was part of an epileptic aura, developed when either the object or the patient moved, and diminished with gabapentin.