"When Perception Deceives: Unmasking Bilateral Occipito-Parietal Infarcts Presenting as Complex Hallucinations and Self-Harm"

This work was sponsored by University of California, San Francisco - Fresno This report delves into the case of a 51-year-old male veteran with a history of CAD and HTN and no past psychiatric history who presented to the emergency department with a self-inflicted arm injury and positive psychiatric symptoms, including CAH, as well as simple and complex VH. After medical stabilization, the patient was followed by the CL team, and eventually admitted to an inpatient psychiatric unit where he was started on Lexapro and Zyprexa with some improvement in symptoms. On the day of discharge, he re-presented to the VA ED with persistent, simple hallucinations and blurred vision. A CT scan of the head revealed recent, bilateral subacute occipito-parietal infarcts, and the patient was admitted to neurosurgery. This case highlights the importance of considering neurological causes for psychiatric symptoms, especially in those without a prior psychiatric history, and sheds light on the unexpected ways in which occipito-parietal lobe infarcts can present. By exploring this patient’s narrative, we can gain a deeper understanding of the complex interplay between the brain and the mind, as well as the crucial role that careful medical investigation plays.