Abstract
A 64-year-old right-handed man acutely developed elementary visual hallucinations (monochromatic, moving geometrical figures), visual illusions (distortion of the right side of faces) with achromatopsia and blurred vision restricted to the left visual hemi-field. CT of the brain before and after administration of contrast medium and a repeat examination 2 months later showed no abnormalities, while brain mapping (power analysis of EEG) demonstrated theta wave slowing of the curve over the posterior part of the right hemisphere.99mTC HMPAO SPECT of the brain, however, demonstrated an area of definite focal hypoperfusion in the right occipito-temporal region. Echo-Doppler-duplex and continuous wave examination of the cervical arterial blood vessels disclosed bilateral discrete atheromatous plaques that did not affect the blood flow. Transoesophageal echocardiography demonstrated slight mitral valve insufficiency. Cerebral angiography showed an occlusion of the right posterior cerebral artery. After the visual hallucinations had subsided, SPECT showed partial normalization of the right occipito-temporal perfusion. In the absence of CT evidence for a structural lesion in the clinically suspected areas, only functional imaging revealed an obviously significant lesion. This case furthermore demonstrates that SPECT can contribute to the identification of the pathophysiology underlying visual hallucinosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abraham HD (1993) Visual hallucinations in macular degeneration. Am J Psychiatry 150: 1758
Davis KR, Taveras JM, New PFJ (1975) Cerebral infarction diagnosis by computerized tomography, Am J Radiol 124: 643–660
Fontaine B, Seilhean D, Tourbah A, Daumas Duport C, Duyckaerts C, Benoit N, Devaux B, Hauw JJ, Rancurel G, Lyon-Caen O (1994) Dementia in two histologically confirmed cases of multiple sclerosis: one case with isolated dementia and one case associated with psychiatric symptoms. J Neurol Neurosurg Psychiatry 57: 353–359
Fujii T, Park C, Koide K, Uno E, Tsuchiya Y (1993) Appearance of hallucinations and one-and-a-half syndrome after resection of a cavernous angioma located in the fourth ventricle floor. No Shinkei Geka 21: 157–161
Gregor JC, Zilli CA, Gotlib IH (1993) Acute psychosis associated with oral trimethoprim-sulfamethoxazole therapy. Can J Psychiatry 38: 56–58
Inafuku T, Sakai F, Sakamoto T, Iizuka T, Kanda T (1994) Visual hallucination in the hemianopic field caused by dural arteriovenous malformation. Rinsho Shinkeigaku 34: 484–488
Kim SM, Park CH, Intenzo CM, Zhang J (1993) Brain SPECT in a patient with post-stroke hallucination. Clin Nucl Med 18: 413–416
Kölmel HW (1991) Peduncular hallucinations. J Neurol 238: 457–459
Kurata A, Miyasaka Y, Yoshida T, Kunii M, Yada K, Kan S (1994) Venous ischemia caused by dural arteriovenous malformation. J Neurosurg 80: 552–555
Lauterbach EC, Spears TE, Prewett MJ, Price ST, Jackson JG, Kirsh AD (1994) Neuropsychiatric disorders, myoclonus, and dystonia in calcification of basal ganglia pathways. Biol Psychiatry 35: 345–351
Lerner AJ, Koss E, Patterson MB, Ownby RL, Hedera P, Friedland RP, Whitehouse PJ (1994) Concomitants of visual hallucinosis in Alzheimer's disease. Neurology 44: 523–527
Loewenstein JI (1994) Visual hallucinations in patients with choroidal neovascularization. JAMA 272: 243
McKee AC, Levine D, Kowall NW, Richardson EP Jr (1990) Peduncular hallucinosis associated with isolated infarction of the substantia nigra pars reticulata. Ann Neurol 27: 500
Musha M, Tanaka F, Ohuti M (1993) Psychosis in three cases with myasthenia gravis and thymoma, proposal of a paraneoplastic auto-immune neuropsychiatric syndrome. Tohoku J Exp Med 169: 335–344
Oldfield R (1971) The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9: 97–113
Palmowski A, Ruprecht KW (1994) Paranoid hallucinations following ocular surgury. Ophthalmologica 208: 44–45
Panayiotopoulos CP (1994) Elementary visual hallucinations in migraine and epilepsy. J Neurol Neurosurg Psychiatry 57: 1371–1374
Patterson S, Silberstein SD (1993) Sometimes Jello helps: perceptions of headache etiology, triggers and treatment in literature. Headache 33: 76–81
Penfield W, Rasmussen P (1950) The cerebral cortex of man. Macmillan, New York
Schultz G, Melzack R (1991) The Charles Bonnet: “phantom visual images”. Perception 20: 809–825
Sichart U, Fuchs T (1992) Visual hallucinations in elderly patients with reduced vision: Charles Bonnet syndrome. Klin Monatsbl Augenheilkd 200: 224–227
Takamatsu K, Takizawa T, Miyamoto T, Ohta T (1994) Partial nuclear oculomotor nerve palsy, MLF syndrome, peduncular hallucinosis due to midbrain infarction, case report. Rinsho Shinkeigaku 34: 341–346
Tanabe K, Yokochi F, Hirai S, Mori H, Suda K, Kondo T, Mizuno Y (1994) A 75-year-old man with parkinsonism and delirium. No To Shinkei 46: 85–92
Van Den Bergen HA, Smith JP, Van Der Zwan A (1993) Lyme Psychose. Ned Tijdschr Geneeskd 137: 2098–2100
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hoksbergen, I., Pickut, B.A., Mariën, P. et al. SPECT findings in an unusual case of visual hallucinosis. J Neurol 243, 594–598 (1996). https://doi.org/10.1007/BF00900947
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00900947