An elderly man with recurrent syncope was admitted with a globe rupture following a syncopal attack. After an initial unremarkable evaluation, the patient reported inversion of the room's wall clock during a bedside evaluation. This symptom is called reversal-of-vision metamorphopsia (RVM) and is a rare visual disturbance that typically results from organic processes localised to the retina and/or posterior cortex of the brain or in some cases is psychogenic in nature. In this case, both the syncope and RVM were caused by impaired circulation in the posterior cortex, and management included an antiplatelet agent, statin and permissive blood pressure targets, which resulted in the correction of RVM.
Keywords: Brain stem / cerebellum; Neuroimaging; Visual pathway.
© BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.