Hemiprosopometamorphopsia: a Case of Impaired Facial Perception Restricted to the Eye

Prosopometamorphopsia is a rare condition of perceptual facial distortion, with no impairment in facial recognition. We report a case of hemiprosopometamorphopsia restricted only to the eye. A 42-year-old male pilot presented with an acute onset visual disturbance consistent with hemiprosopometamorphopsia. While looking at faces, he observed a distorted image with the left eye appearing lower than the right. Faces resembled the paintings of Picasso. He had preserved insight and could recognize faces. Neurological and ophthalmological examination revealed no abnormalities. A brain MRI performed on day 3 of symptom onset demonstrated an area of acute infarct in the right occipital lobe involving the right posterior cerebral artery territory. Carotid CT angiogram and circle of Willis were unremarkable. Further workup did not reveal an underlying cause. Secondary stroke prevention with aspirin and statin was initiated. An event recorder was implanted. He was discharged on day 8 with near complete resolution of presenting symptom. While various facial distortions have been reported from prosopometamorphopsia, our case was restricted to only the eye and could have been easily overlooked or misdiagnosed as a migraine phenomenon. In patients presenting with perceptual facial distortion, clinicians should consider the possibility of stroke.