Visual hallucinations in the context of psychosis and focal seizures

We report a case of a 72-year-old male who, after traumatic brain injury (TBI), presented with a sudden onset of behavioral abnormalities and well-formed visual hallucinations (episodic) that were primarily present on his left side of vision. He was initially referred to psychiatry, as his symptoms were thought to be a behavioral sequela of TBI. However, the visual hallucinations warranted further investigation. Further evaluation revealed that the hallucinations were secondary to seizures triggered by the TBI. While behavioral issues and seizures post-TBI are documented, this case is unique for presenting both psychiatric and neurological symptoms. The dilemma regarding the origin of his hallucinations was resolved by video electroencephalogram monitoring, confirming they were seizure-related rather than just post-TBI behavioral sequelae. His hallucinations were completely resolved with antiseizure medications. This highlights the challenges in diagnosing and managing visual hallucinations, stressing the need for a multidisciplinary approach to avoid misdiagnosis and ensure effective treatment.