Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Neurological Rehabilitation

Complex Visual Hallucinations Following a Subdural Hematoma: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 6

    Poster Presenter(s)

  • Ana Portilla Fernandez, MD (she/her/hers)

    International Medical Graduate
    Universidad Francisco Marroqu�n
    Baldwinsville, New York

    • Co-Author(s)

  • YZ

    Yi Zhou, MD

    Brain Injury Fellow
    MassGeneral Brigham/Spaulding Rehabilitation/Harvard Medical School PM&R Program
    Somerville, Massachusetts

  • SS

    Shirley Shih, MD

    Medical Director Inpatient Brain Injury
    Spaulding Rehabilitation Hospital/Harvard Medical School PM&R Program
    Allston, Massachusetts

Disclosure(s):
Ana Portilla Fernandez, MD: No financial relationships to disclose
Case Diagnosis: 75-year-old male with right-sided subdural hematoma (SDH) secondary to mechanical fall.

Case Description or Program Description: Patient's right-sided subdural hematoma was treated with a craniotomy. An EEG was performed after the presentation of seizures with unknown semiology, which suggested occipital-parietal seizures per neurology. He developed complex visual hallucinations in his left visual field, such as misinterpreting photographs and seeing animals that were not present. These symptoms were not associated with any triggers, vision deficits (intact peripheral vision, no change in visual acuity), aura, or other symptoms.

Setting: Acute inpatient rehabilitation facility (IRB)

Assessment/Results: He was already on multiple antiseizure medications (Levetiracetam, Valproic Acid, and Lacosamide), then, the dosage of Valproic Acid was increased, which resolved the symptoms.

Discussion (relevance): The prevalence of visual hallucinations after traumatic brain injury (TBI) is unknown, though they have been reported in literature, particularly in case reports. Seizures cause visual hallucinations through cortical irritation, neurotransmitter imbalance, altered connectivity, astrocyte dysfunction, and abnormal oscillations in TBI. Elementary hallucinations, such as flashes of light, are more common and typically linked to the occipital lobe, while complex hallucinations, which are more detailed, are often associated with the occipital and parietal lobes. Literature suggests that antiseizure medications can reduce the frequency of these symptoms, supporting seizures as a primary cause. While Charles Bonnet syndrome, characterized by complex hallucinations and visual impairments, remains a secondary consideration, cortical dysfunction alone can sometimes produce similar symptoms, even without significant visual impairment. This case highlights the importance of recognizing and addressing the causes of visual hallucinations following TBI.

Conclusions: Complex visual hallucinations following TBI are rare, and related literature is limited. Further research is needed to better understand their mechanism. Given the challenge of clarifying the cause, increased awareness and further studies are crucial for improving recognition and management.