A strange smell and visions in a 45-year-old man with focal epilepsy

A 45-year-old man with a 5-year history of episodes of smelling a strange odour followed by seeing images of scenes from his childhood, attended our psychiatry department. The patient said that after experiencing the smell and the images, he felt shivery, had piloerection, and was short of breath; each episode lasted about 1 min, with no impairment of consciousness or abnormal movements. The problem tended to occur when he was tired, or sleep deprived. Previously, the episodes occurred once every 3 months, but recently—as his work had become more demanding—they happened more frequently; in the previous month, prior to presenting, they had occurred weekly. The patient reported no accompanying headache and had no history of medical or psychiatric illness.