A 16-year-old male case of post-ictal headache due to occipital lobe epilepsy with ulegyria that required differentiation from migraine with aura

Abstract

　The patient is a 16-year-old male who had generalized tonic-clonic seizures after visual symptoms and was admitted to the hospital. MRI showed bilateral occipital lobe ulegyria. The patient had been experiencing occipital pain followed by a pattern of dots appearing on the left side of the visual field for 6 years, which had increased in frequency. The pattern of visual symptoms was thought to be elemental visual hallucinations of occipital lobe epilepsy rather than an aura of migraine. Elemental visual hallucinations in migraine have zigzagging patterns that move slowly to the periphery of the visual field, whereas in occipital lobe epilepsy, they are circular or point-like and move rapidly to the center of the visual field or contralateral to the site of its appearance. Administration of levetiracetam reduced the posterior headache with visual aura, and it passed without recurrence of seizures. A detailed history of visual symptoms and head MRI images may be useful in differentiating occipital lobe epilepsy from migraine with aura．