Violent visual hallucinations and aggression in frontal lobe dysfunction: clinical manifestations of deep orbitofrontal foci.

Three patients from different racial, social, and economic backgrounds were studied because of sudden intrusive thoughts: visions or intrusions of threatening scenes--violent, aggressive, and sometimes horrifying--that lasted from seconds to minutes. Apart from the association with intense anxiety, fear, and aggression, there was no association with oculomotor, motor, sensory, or autonomic dysfunction or altered conscious state. Patients had abnormal intermittent discharges that arose from frontal areas and probably did not spread further. Carbamazepine was useful in two cases. The authors suggest that violent, brief hallucinations with no other epileptic sign may be manifestations of frontal lobe seizures.