Jasvir Virdee and Susan Mollan describe a patient presenting with photopsia who had an unusual ophthalmological diagnosis. Positive and/or negative visual phenomena may relate to pathology anywhere from the eye to the visual association cortex; thus, neurologists and ophthalmologists share responsibility for diagnosing and treating these symptoms. The authors describe how they arrived at an ophthalmological diagnosis for their patient’s photopsia; here I briefly discuss its neurological aspects, especially relating to epilepsy.

The occipital lobes are the smallest lobes of the brain, approximately 13% of brain volume. Even so, occipital epilepsy still seems relatively uncommon, especially compared with that from the temporal lobes (20% of brain volume). Panayiotopoulos found occipital epilepsy to comprise only 4.6% of a large series of childhood epilepsy¹ and case series of patients undergoing epilepsy surgery for refractory epilepsy have only very small numbers.^2–4 The most recent International League Against Epilepsy classification of seizure types, unhelpfully for this discussion, avoids talking about lobes, perhaps recognising the problems of trying to pin down clinical patterns anatomically.⁵

It was Gowers who first described in detail seizures with visual aura.⁶ Gordon Holmes described patients with occipital lesions who experienced vivid, coloured hallucinations localised to a specific part …