Brain, Vol 121, Issue 10 1819-1840, Copyright © 1998 by Oxford University Press
M Manford and F Andermann
Complex visual hallucinations may affect some normal individuals on going
to sleep and are also seen in pathological states, often in association
with a sleep disturbance. The content of these hallucinations is striking
and relatively stereotyped, often involving animals and human figures in
bright colours and dramatic settings. Conditions causing these
hallucinations include narcolepsy-cataplexy syndrome, peduncular
hallucinosis, treated idiopathic Parkinson's disease, Lewy body dementia
without treatment, migraine coma, Charles Bonnet syndrome (visual
hallucinations of the blind), schizophrenia, hallucinogen-induced states
and epilepsy. We describe cases of hallucinosis due to several of these
causes and expand on previous hypotheses to suggest three mechanisms
underlying complex visual hallucinations. (i) Epileptic hallucinations are
probably due to a direct irritative process acting on cortical centres
integrating complex visual information. (ii) Visual pathway lesions cause
defective visual input and may result in hallucinations from defective
visual processing or an abnormal cortical release phenomenon. (iii)
Brainstem lesions appear to affect ascending cholinergic and serotonergic
pathways, and may also be implicated in Parkinson's disease. These
brainstem abnormalities are often associated with disturbances of sleep. We
discuss how these lesions, outside the primary visual system, may cause
defective modulation of thalamocortical relationships leading to a release
phenomenon. We suggest that perturbation of a distributed matrix may
explain the production of similar, complex mental phenomena by relatively
blunt insults at disparate sites.
REVIEWS
Complex visual hallucinations. Clinical and neurobiological insights
Department of Clinical Neurology, Addenbrooke's Hospital, Cambridge, UK. Markmanford@gransden.prestel.co.uk
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