Occipital lobe epilepsy presenting as Charles Bonnet syndrome

Charles Bonnet syndrome describes visual field or acuity loss with complex hallucinations. This typically occurs in the elderly with preexisting visual impairment. We describe a patient who presented to the emergency department with acute hemianopsia and intermittent complex hallucinations. A 57-year-old man was referred for visual field loss and hallucinations. Chief complaint was “seeing little heads of people” and a right-sided visual loss. The patient was alert, oriented, and able to repeat and name and had fluent speech. On cranial nerve examination, he had 20/20 visual acuity and right homonymous hemianopsia. The patient had normal laboratory examination and electrocardiogram results. Results of computed tomography and magnetic resonance imaging of the head with contrast were negative. Standard 30-minute electroencephalography revealed near-continuous epileptiform discharges in the left occipital lobe. To our knowledge, this is the first case report of new-onset seizure presenting as Charles Bonnet syndrome.