Abstracts

Rationale: To describe an interesting case of seizure with onset and primary manifestation of a lack of spatial reasoning. Methods: This is a case report and review of the literature. Results: The case is of a 16 yo right handed young lady, with no other PMH, who presented with a 1 year history of spatial disorientation symptoms. When episodes were witnessed by others she was noted to have the initial visual symptoms followed by left head turn and convulsion.  The patient was amnestic to all but the visual symptoms and sometimes the head turn.  The patient had ongoing brief episodes of spatial disorientation symptoms, which she described as an inability to “figure out how to place myself within the environment” because “I just have no idea if I’m farther or closer [to an object]”. She described this as her "spatial reasoning" being affected.  Unlike in other visual perception related issues, like Alice in Wonderland syndrome for example, there is no distortion to the images.  No optic ataxia is noted during the events.  MRI of the brain was normal. Prolonged EEG monitoring captured seizures, and demonstrated an EEG correlate with spikes phase reversing in the P2, POz and O2 electrodes. Conclusions: Disruption of "spatial reasoning" is reported as a primary seizure manifestation. No other cases in the literature are described with this discrete symptomatology.  This case demonstrates localization with EEG of the spatial reasoning symptoms, likely to visual association cortex. Included will be a literature review of spatial and visual manifestations of seizures in the occipital parietal region. Funding: No funding was recieved.