Case Report Reversal of vision metamorphopsia: A manifestation of focal seizure due to cortical dysplasia Aysun Unal a , Ays ßenur Cila b , Serap Saygi a, * a Department of Neurology, School of Medicine, Hacettepe University, Ankara, Turkey b Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey Received 7 August 2005; revised 23 August 2005; accepted 24 August 2005 Available online 24 October 2005 Abstract Upside-down reversal of vision has rarely been reported in the literature. The reported causes are diverse, including poste lation stroke, tumors, trauma, and multiple sclerosis. The term seizure has been used in only two cases in the literature, the was stroke. To our knowledge, this is the first reported case of cortical dysplasia in the posterior parietal cortex as the cause partialseizures beginning with upside-down reversal of vision.As the pathophysiological characteristics of this phenomenon remain unclear, this case implies that the posterior parietal cortex is a possible anatomical localization of the central integrator of vi personal orientation. Ó 2005 Elsevier Inc. All rights reserved. Keywords:Upside-down vision; Reversal of vision; Metamorphopsia; Seizure 1. Introduction Space perception provides information about where ob- jects are in the environment and how they move. It may be dissociated from pattern perception, which provides infor- mation about what the objects are and how they are char- acterized [1]. The posterior parietal cortex is the most likely area of the brain related to space perception tasks, as le- sions in this area in humans cause visual deterioration [1,2]. Metamorphopsia isa visualillusion thatdistortsthe size,shape,or inclination ofobjects.Reversalof vision metamorphopsia (RVM) is a transient form of metamor- phopsia described as an upside-down, 180° alteration of the visual field in the coronal plane [3]. The reported causes of this rare manifestation are diverse, including stroke, tu- mors, trauma, and multiple sclerosis [4–15]. The pathogen- esis underlying RVM is uncertain.Becausethe visual images enter the retina inverted, a transient failure of the mechanisms mediating reinversion is strongly suggested to be the cause [2,3]. The transient nature of the phenomenon has been evi- dent since the first report by Winslow [7]. To our knowl- edge, there are reports of only two patients who exhibited this phenomenon as the sign of a seizure in the English lit- erature [3,8]. In this study we present another case with complex partial seizures beginning with the upside-down reversal of vision.Left parieto-occipital corticaldysplasia was detectedby brain magneticresonanceimaging (MRI). This case implies that parieto-occipital cortex hous- es a neural representation of space that can guide the ac- tions necessary for manipulating objects in the environment. 2. Case report A 16-year-old, right handed, male patient was admitted because of two attacks beginning with complete reversal o his vision and then loss of consciousness for a few minutes He could remember and described clearly the upside-down vision just before the loss of consciousness. Medical history 1525-5050/$ - see front matter Ó 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2005.08.012 * Corresponding author. Fax: +90 312 3093451. E-mail address: ssaygi@hacettepe.edu.tr (S. Saygi). www.elsevier.com/locate/yebeh Epilepsy & Behavior 8 (2006) 308–311