Inverted Metamorphopsia as a Symptom of Cognitive Epilepsy

A Case Report

Abstract

Objective: A rare case of inverted metamorphopsia crises is reported, a visuospatial disorder characterized by the rotation of the visual field at abnormal angles, triggered by focal cognitive-perceptual epilepsy. The difficulty in diagnosis and causal determination arises from the atypical presentation of the disease and its uncommon etiology compared to other examples described in the literature. The patient, 58 years old at the onset of symptoms and obese without a history of other comorbidities, reported recurrent episodes of visual disorientation with a sensation of the environment being “mirrored,” which impaired spatial orientation. Nevertheless, he managed to orient himself by reversing his usual directions. The patient showed no significant changes in neurological examinations or screening tests, and the only finding on magnetic resonance imaging (MRI)—a microadenoma—was not related to the clinical picture. The initial therapeutic approach was the prescription of an antiepileptic drug (lamotrigine) to control symptoms and prevent future accidents.