Occipital status epilepticus: an unusual case of post-traumatic blindness

Post-traumatic seizures can be a cause of multiple clinical and behavioral abnormalities. We present an unusual case of post-traumatic epilepsy resulting in blindness. The patient was a 35-year-old female with a past history of toxemia of pregnancy who was assaulted, sustaining a traumatic brain injury (TBI). Glasgow Coma Score upon presentation to the emergency department was 10. Initial CAT scan was negative. Subsequent MRI revealed occipital edema. On examination, she was found to be blind in both eyes. Consistent with cortical blindness, extra-ocular movements, pupillary reflexes and fundoscopic examination were normal. Unusual scanning eye movements were noted. Electroencephalography (EEG) revealed epileptiform discharges in both occipital regions consistent with occipital status epilepticus. Seizures were eventually controlled with Phenytoin and Phenobarbital, with subsequent conversion to Carbamazepine. Central vision returned, but peripheral sight was never regained. Follow up EEG revealed no evidence of epileptiform activity. Post-traumatic occipital status epilepticus is rare. Cortical blindness in TBI patients with minimal occipital pathology on imaging is generally transient. This case points out the need for the treating rehabilitation professional to be vigilant in assessing for post-traumatic seizures in patients with persisting visual deficits.