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Haarsma J, Deveci N, Corbin N, Callaghan MF, Kok P. Expectation Cues and False Percepts Generate Stimulus-Specific Activity in Distinct Layers of the Early Visual Cortex. J Neurosci 2023; 43:7946-7957. [PMID: 37739797 PMCID: PMC10669763 DOI: 10.1523/jneurosci.0998-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
Perception has been proposed to result from the integration of feedforward sensory signals with internally generated feedback signals. Feedback signals are believed to play an important role in driving false percepts, that is, seeing things that are not actually there. Feedforward and feedback influences on perception can be studied using layer-specific fMRI, which we used here to interrogate neural activity underlying high-confidence false percepts while healthy human participants (N = 25, male and female) performed a perceptual orientation discrimination task. Auditory cues implicitly signaled the most likely upcoming orientation (referred to here as expectations). These expectations induced orientation-specific templates in the deep and superficial layers of V2, without affecting perception. In contrast, the orientation of falsely perceived stimuli with high confidence was reflected in the middle input layers of V2, suggesting a feedforward signal contributing to false percepts. The prevalence of high-confidence false percepts was related to everyday hallucination severity in a separate online sample (N = 100), suggesting a possible link with abnormal perceptual experiences. These results reveal a potential feedforward mechanism underlying false percepts, reflected by spontaneous stimulus-like activity in the input layers of the visual cortex, independent of top-down signals reflecting cued orientations.SIGNIFICANCE STATEMENT False percepts have been suggested to arise through excessive feedback signals. However, feedforward contributions to false percepts have remained largely understudied. Laminar fMRI has been shown to be useful in distinguishing feedforward from feedback activity as it allows the imaging of different cortical layers. In the present study we demonstrate that although cued orientations are encoded in the feedback layers of the visual cortex, the content of the false percepts are encoded in the feedforward layers and did not rely on these cued orientations. This shows that false percepts can in principle emerge from random feedforward signals in the visual cortex, with possible implications for disorders hallmarked by hallucinations like schizophrenia and Parkinson's disease.
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Affiliation(s)
- Joost Haarsma
- Wellcome Centre for Human Neuroimaging, University College London Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom
| | - Narin Deveci
- Wellcome Centre for Human Neuroimaging, University College London Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom
| | - Nadege Corbin
- Wellcome Centre for Human Neuroimaging, University College London Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom
- Centre de Résonance Magnétique des Systèmes Biologiques, Unité Mixte de Recherche 5536, Centre National de la Recherche Scientifique, Université de Bordeaux, 33076 Bordeaux, France
| | - Martina F Callaghan
- Wellcome Centre for Human Neuroimaging, University College London Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom
| | - Peter Kok
- Wellcome Centre for Human Neuroimaging, University College London Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom
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Blackman G, Neri G, Al-Doori O, Teixeira-Dias M, Mazumder A, Pollak TA, Hird EJ, Koutsouleris N, Bell V, Kempton MJ, McGuire P. Prevalence of Neuroradiological Abnormalities in First-Episode Psychosis: A Systematic Review and Meta-analysis. JAMA Psychiatry 2023; 80:1047-1054. [PMID: 37436735 PMCID: PMC10339221 DOI: 10.1001/jamapsychiatry.2023.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/08/2023] [Indexed: 07/13/2023]
Abstract
Importance Individuals presenting with first-episode psychosis (FEP) may have a secondary ("organic") etiology to their symptoms that can be identified using neuroimaging. Because failure to detect such cases at an early stage can have serious clinical consequences, it has been suggested that brain magnetic resonance imaging (MRI) should be mandatory for all patients presenting with FEP. However, this remains a controversial issue, partly because the prevalence of clinically relevant MRI abnormalities in this group is unclear. Objective To derive a meta-analytic estimate of the prevalence of clinically relevant neuroradiological abnormalities in FEP. Data Sources Electronic databases Ovid, MEDLINE, PubMed, Embase, PsychINFO, and Global Health were searched up to July 2021. References and citations of included articles and review articles were also searched. Study Selection Magnetic resonance imaging studies of patients with FEP were included if they reported the frequency of intracranial radiological abnormalities. Data Extraction and Synthesis Independent extraction was undertaken by 3 researchers and a random-effects meta-analysis of pooled proportions was calculated. Moderators were tested using subgroup and meta-regression analyses. Heterogeneity was evaluated using the I2 index. The robustness of results was evaluated using sensitivity analyses. Publication bias was assessed using funnel plots and Egger tests. Main Outcomes and Measures Proportion of patients with a clinically relevant radiological abnormality (defined as a change in clinical management or diagnosis); number of patients needed to scan to detect 1 such abnormality (number needed to assess [NNA]). Results Twelve independent studies (13 samples) comprising 1613 patients with FEP were included. Of these patients, 26.4% (95% CI, 16.3%-37.9%; NNA of 4) had an intracranial radiological abnormality, and 5.9% (95% CI, 3.2%-9.0%) had a clinically relevant abnormality, yielding an NNA of 18. There were high degrees of heterogeneity among the studies for these outcomes, 95% to 73%, respectively. The most common type of clinically relevant finding was white matter abnormalities, with a prevalence of 0.9% (95% CI, 0%-2.8%), followed by cysts, with a prevalence of 0.5% (95% CI, 0%-1.4%). Conclusions and Relevance This systematic review and meta-analysis found that 5.9% of patients presenting with a first episode of psychosis had a clinically relevant finding on MRI. Because the consequences of not detecting these abnormalities can be serious, these findings support the use of MRI as part of the initial clinical assessment of all patients with FEP.
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Affiliation(s)
- Graham Blackman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Giulia Neri
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Omar Al-Doori
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Maria Teixeira-Dias
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Asif Mazumder
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Thomas A. Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily J. Hird
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Nikolaos Koutsouleris
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
| | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Winton-Brown T, Smith L, Laing J, O'Brien T, Neal A. Ictal face perception disturbance, tattoos, and reclaiming the self. Epilepsy Behav Rep 2023; 22:100595. [PMID: 37025370 PMCID: PMC10070365 DOI: 10.1016/j.ebr.2023.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
We present a case of a young man with frightening ictal disturbance of face perception, or prosopometamorphopsia, arising from the left temporo-occipital region, leading to significant psychosocial impairment. A vivid forearm tattoo of the ictal experience conveyed its nature to the treating team and facilitated a psychotherapeutic process leading to significant psychosocial recovery. This case highlights the marked psychosocial and developmental impacts of epilepsy and the benefit of incorporating these into assessment and treatment.
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Choi W, Lee SJ, Ko SH, Shin YI, Min JH. Peduncular Hallucinosis 7 Months After Pontine Hemorrhage With Hypertrophic Olivary Degeneration: A Case Report. BRAIN & NEUROREHABILITATION 2022; 15:e31. [PMID: 36742085 PMCID: PMC9833485 DOI: 10.12786/bn.2022.15.e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 12/05/2022] Open
Abstract
Peduncular hallucinosis is a rare type of hallucination, wherein patients see colorful and vivid images. It usually appears after damage to the midbrain, pons, or thalamus. We report the case of a 56-year-old man with peduncular hallucinosis after conservative care for spontaneous pontine hemorrhage, 7 months prior to presentation. He was treated with atypical antipsychotics, which resolved the symptoms. We suggest that it is important to consider peduncular hallucinosis in patients after injuries in subcortical areas and the brainstem. Additionally, we found changes in the hypertrophic olivary degeneration using magnetic resonance imaging, and we suggest the possibility of their correlation with peduncular hallucinosis.
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Affiliation(s)
- Woosik Choi
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - So Jung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Eagleman DM, Vaughn DA. The Defensive Activation Theory: REM Sleep as a Mechanism to Prevent Takeover of the Visual Cortex. Front Neurosci 2021; 15:632853. [PMID: 34093109 PMCID: PMC8176926 DOI: 10.3389/fnins.2021.632853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Regions of the brain maintain their territory with continuous activity: if activity slows or stops (e.g., because of blindness), the territory tends to be taken over by its neighbors. A surprise in recent years has been the speed of takeover, which is measurable within an hour. These findings lead us to a new hypothesis on the origin of REM sleep. We hypothesize that the circuitry underlying REM sleep serves to amplify the visual system's activity periodically throughout the night, allowing it to defend its territory against takeover from other senses. We find that measures of plasticity across 25 species of primates correlate positively with the proportion of rapid eye movement (REM) sleep. We further find that plasticity and REM sleep increase in lockstep with evolutionary recency to humans. Finally, our hypothesis is consistent with the decrease in REM sleep and parallel decrease in neuroplasticity with aging.
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Affiliation(s)
- David M. Eagleman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Don A. Vaughn
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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6
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Lenka A, Ingalhalikar M, Shah A, Saini J, Arumugham SS, Hegde S, George L, Yadav R, Pal PK. Abnormalities in the white matter tracts in patients with Parkinson disease and psychosis. Neurology 2020; 94:e1876-e1884. [PMID: 32317347 DOI: 10.1212/wnl.0000000000009363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/15/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The objective of the current study was to compare the microstructural integrity of the white matter (WM) tracts in patients having Parkinson disease (PD) with and without psychosis (PD-P and PD-NP) through diffusion tensor imaging (DTI). METHODS This cross-sectional study involved 48 PD-NP and 42 PD-P who were matched for age, sex, and education. Tract-based spatial statistics (TBSS) was used to compare several DTI metrics from the diffusion-weighted MRIs obtained through a 3-Tesla scanner. A set of neuropsychological tests was used for the cognitive evaluation of all patients. RESULTS The severity and stage of PD were not statistically different between the groups. The PD-P group performed poorly in all the neuropsychological domains compared with the PD-NP group. TBSS analysis revealed widespread patterns of abnormality in the fractional anisotropy (FA) in the PD-P group, which also correlated with some of the cognitive scores. These tracts include inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, right parieto-occipital WM, body of the corpus callosum, and corticospinal tract. CONCLUSION This study provides novel insights into the putative role of WM tract abnormalities in the pathogenesis of PD-P by demonstrating significant alterations in several WM tracts. Additional longitudinal studies are warranted to confirm the findings of our research.
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Affiliation(s)
- Abhishek Lenka
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Madhura Ingalhalikar
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Apurva Shah
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Jitender Saini
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shyam Sundar Arumugham
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shantala Hegde
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Lija George
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Ravi Yadav
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Pramod Kumar Pal
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC.
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8
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Prefrontal neural dynamics in consciousness. Neuropsychologia 2019; 131:25-41. [DOI: 10.1016/j.neuropsychologia.2019.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022]
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O'Farrell L, Lewis S, McKenzie A, Jones L. Charles Bonnet Syndrome: A Review of the Literature. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x1010400502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Charles Bonnet syndrome (CBS) commonly occurs in older adults with visual impairments, particularly those with age-related macular degeneration. It is characterized by complex visual hallucinations in individuals without mental disorders. The authors explore diagnostic criteria, demographic characteristics, clinical features, theories of pathogenesis, and management options for people who are diagnosed with CBS.
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Affiliation(s)
- Lauren O'Farrell
- Charlie Norwood VA Medical Center, One Freedom Way, Augusta, GA 30904
| | - Sandra Lewis
- Florida State University, 2205 Stone Building, Tallahassee, FL 32306-4459
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10
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Couse M, Wojtanowicz T, Comeau S, Bota R. Peduncular hallucinosis associated with a pontine cavernoma. Ment Illn 2018; 10:7586. [PMID: 30046405 PMCID: PMC6037096 DOI: 10.4081/mi.2018.7586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/18/2018] [Indexed: 11/23/2022] Open
Abstract
Peduncluar hallucinosis is a rare neurological disorder characterized by visual hallucinations, often described to be vivid and dream-like. While the exact pathophysiology has yet to be elucidated, most cases to date have suggested an etiology stemming from lesions to the thalamus or midbrain. Here presented is a case of a 54-year-old female with peduncular hallucinosis secondary to a pontine cavernoma hemorrhage in the setting of essential hypertension. The patient’s vivid visual and auditory hallucinations aligned temporally with the lesion’s discovery and resolved after pharmaceutical treatment. This case represents a rare form of peduncular hallucinosis secondary to a pontine cavernoma hemorrhage leading to vasospasm in the arteries feeding the brain-stem.
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11
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Seeing for ourselves: Insights into the development of moral behaviour from models of visual perception and misperception. Behav Brain Sci 2018; 41:e40. [DOI: 10.1017/s0140525x17000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractParallels from visual processing support Doris's cognitive architecture underlying moral agency. Unconscious visual processes change with conscious reflection. The sparse and partial representations of vision, its illusions, and hallucinations echo biases in moral reasoning and behaviour. Traditionally, unconscious moral processes are developed by teaching and reflection. Modern neuroscience could bypass reflection and directly influence unconscious processes, creating new dangers.
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Abstract
Supplemental digital content is available in the text. Charles Bonnet Syndrome is a condition where visual hallucinations occur as a result of damage along the visual pathway. Patients with Charles Bonnet Syndrome maintain partial or full insight that the hallucinations are not real, absence of psychological conditions, and absence of hallucinations affecting other sensory modalities, while maintaining intact intellectual functioning. Charles Bonnet Syndrome has been well documented in neurologic, geriatric medicine, and psychiatric literature, but there is lack of information in optometric and ophthalmologic literature. Therefore, increased awareness of signs and symptoms associated with Charles Bonnet Syndrome is required among practicing clinicians. This review of the literature will also identify other etiologies of visual hallucinations, pathophysiology of Charles Bonnet Syndrome, and effective management strategies.
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13
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Philip M, Kornitzer J, Marks D, Lee HJ, Souayah N. Alice in Wonderland Syndrome associated with a temporo-parietal cavernoma. Brain Imaging Behav 2016; 9:910-2. [PMID: 25663031 DOI: 10.1007/s11682-015-9355-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Alice in Wonderland Syndrome (AIWS) is characterized by a rare constellation of perceptual disturbances including distorted body image, metamorphopsia, and visual hallucinations. In this report, we relate a unique case of AIWS in a woman with a right temporo-parietal cavernoma. AIWS in this patient may be secondary to epileptiform activity associated with the cavernoma and improved with anti-epileptic treatment.
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Affiliation(s)
- Michelle Philip
- Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, 185 South Orange Ave, Newark, NJ, 07101-1709, USA.
| | - Jeffery Kornitzer
- Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, 185 South Orange Ave, Newark, NJ, 07101-1709, USA
| | - David Marks
- Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, 185 South Orange Ave, Newark, NJ, 07101-1709, USA
| | - Huey-Jen Lee
- Department of Radiology, Rutgers-New Jersey Medical School, Newark, NJ, 07101-1709, USA
| | - Nizar Souayah
- Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, 185 South Orange Ave, Newark, NJ, 07101-1709, USA
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Winton-Brown TT, Ting A, Mocellin R, Velakoulis D, Gaillard F, Gaillard F. Distinguishing Neuroimaging Features in Patients Presenting with Visual Hallucinations. AJNR Am J Neuroradiol 2016; 37:774-81. [PMID: 26744445 DOI: 10.3174/ajnr.a4636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Visual hallucinations are relatively uncommon presentations in medical and psychiatric clinics, where they are generally regarded as a marker of possible underlying "organic" brain disease. Thus, patients with visual hallucinations are often referred for imaging of the brain. This article presents a pragmatic approach for the radiologist reviewing such imaging. Because conditions that can present with visual hallucinations are legion, a familiarity with the features of the hallucinations themselves, which can serve as clues to the underlying cause, can be helpful in interpreting such cases. We consider the nature of visual hallucinations and the mechanisms underlying their formation. We then provide a framework to guide the search for their cause, first in terms of focal lesions along the visual pathway and then global conditions affecting >1 region.
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Affiliation(s)
| | | | | | | | | | - F Gaillard
- Radiology (A.T., F.G.), Royal Melbourne Hospital, Parkville, Victoria, Australia
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Boes AD, Prasad S, Liu H, Liu Q, Pascual-Leone A, Caviness VS, Fox MD. Network localization of neurological symptoms from focal brain lesions. Brain 2015; 138:3061-75. [PMID: 26264514 DOI: 10.1093/brain/awv228] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/22/2015] [Indexed: 01/31/2023] Open
Abstract
A traditional and widely used approach for linking neurological symptoms to specific brain regions involves identifying overlap in lesion location across patients with similar symptoms, termed lesion mapping. This approach is powerful and broadly applicable, but has limitations when symptoms do not localize to a single region or stem from dysfunction in regions connected to the lesion site rather than the site itself. A newer approach sensitive to such network effects involves functional neuroimaging of patients, but this requires specialized brain scans beyond routine clinical data, making it less versatile and difficult to apply when symptoms are rare or transient. In this article we show that the traditional approach to lesion mapping can be expanded to incorporate network effects into symptom localization without the need for specialized neuroimaging of patients. Our approach involves three steps: (i) transferring the three-dimensional volume of a brain lesion onto a reference brain; (ii) assessing the intrinsic functional connectivity of the lesion volume with the rest of the brain using normative connectome data; and (iii) overlapping lesion-associated networks to identify regions common to a clinical syndrome. We first tested our approach in peduncular hallucinosis, a syndrome of visual hallucinations following subcortical lesions long hypothesized to be due to network effects on extrastriate visual cortex. While the lesions themselves were heterogeneously distributed with little overlap in lesion location, 22 of 23 lesions were negatively correlated with extrastriate visual cortex. This network overlap was specific compared to other subcortical lesions (P < 10(-5)) and relative to other cortical regions (P < 0.01). Next, we tested for generalizability of our technique by applying it to three additional lesion syndromes: central post-stroke pain, auditory hallucinosis, and subcortical aphasia. In each syndrome, heterogeneous lesions that themselves had little overlap showed significant network overlap in cortical areas previously implicated in symptom expression (P < 10(-4)). These results suggest that (i) heterogeneous lesions producing similar symptoms share functional connectivity to specific brain regions involved in symptom expression; and (ii) publically available human connectome data can be used to incorporate these network effects into traditional lesion mapping approaches. Because the current technique requires no specialized imaging of patients it may prove a versatile and broadly applicable approach for localizing neurological symptoms in the setting of brain lesions.
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Affiliation(s)
- Aaron D Boes
- 1 Berenson-Allen Centre for Non-invasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Centre, 330 Brookline Ave, Boston, MA, 02215, USA 2 Department of Paediatric Neurology, Massachusetts General Hospital, Harvard Medical School, Mailcode: WACC 8-835, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sashank Prasad
- 3 Department of Neurology, Division of Neuro-Ophthalmology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston MA 02115, USA
| | - Hesheng Liu
- 4 Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA
| | - Qi Liu
- 4 Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA 5 National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, P. R. China
| | - Alvaro Pascual-Leone
- 1 Berenson-Allen Centre for Non-invasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Centre, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Verne S Caviness
- 2 Department of Paediatric Neurology, Massachusetts General Hospital, Harvard Medical School, Mailcode: WACC 8-835, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Michael D Fox
- 1 Berenson-Allen Centre for Non-invasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Centre, 330 Brookline Ave, Boston, MA, 02215, USA 4 Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA 6 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Mailcode: WACC 8-835, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Addy PH, Garcia-Romeu A, Metzger M, Wade J. The subjective experience of acute, experimentally-induced Salvia divinorum inebriation. J Psychopharmacol 2015; 29:426-35. [PMID: 25691501 DOI: 10.1177/0269881115570081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the overall psychological effects of inebriation facilitated by the naturally-occurring plant hallucinogen Salvia divinorum using a double-blind, randomized, placebo-controlled trial. Thirty healthy individuals self-administered Salvia divinorum via combustion and inhalation in a quiet, comfortable research setting. Experimental sessions, post-session interviews, and 8-week follow-up meetings were audio recorded and transcribed to provide the primary qualitative material analyzed here. Additionally, post-session responses to the Hallucinogen Rating Scale provided a quantitative groundwork for mixed-methods discussion. Qualitative data underwent thematic content analysis, being coded independently by three researchers before being collaboratively integrated to provide the final results. Three main themes and 10 subthemes of acute intoxication emerged, encompassing the qualities of the experience, perceptual alterations, and cognitive-affective shifts. The experience was described as having rapid onset and being intense and unique. Participants reported marked changes in auditory, visual, and interoceptive sensory input; losing normal awareness of themselves and their surroundings; and an assortment of delusional phenomena. Additionally, the abuse potential of Salvia divinorum was examined post hoc. These findings are discussed in light of previous research, and provide an initial framework for greater understanding of the subjective effects of Salvia divinorum, an emerging drug of abuse.
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Affiliation(s)
- Peter H Addy
- Medical Informatics, VA Connecticut Healthcare System, West Haven, CT, USA Department of Medical Informatics, Yale University School of Medicine, New Haven, CT, USA
| | - Albert Garcia-Romeu
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Preclinical polymodal hallucinations for 13 years before dementia with Lewy bodies. Behav Neurol 2014; 2014:694296. [PMID: 24868122 PMCID: PMC4020531 DOI: 10.1155/2014/694296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/29/2013] [Indexed: 01/08/2023] Open
Abstract
Objective. We describe a case of dementia with Lewy bodies (DLB) that presented long-lasting preclinical complex polymodal hallucinations. Background. Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI-) DLB is poorly understood. Methods. The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage. Results. The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS). The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB. Conclusions. This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder.
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Lana-Peixoto MA. Complex visual hallucinations in mentally healthy people. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:331-332. [PMID: 24863506 DOI: 10.1590/0004-282x20140050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Marco A Lana-Peixoto
- Departamento de Neuro-Oftalmologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Shine JM, O'Callaghan C, Halliday GM, Lewis SJG. Tricks of the mind: Visual hallucinations as disorders of attention. Prog Neurobiol 2014; 116:58-65. [PMID: 24525149 DOI: 10.1016/j.pneurobio.2014.01.004] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
Visual hallucinations are common across a number of disorders but to date, a unifying pathophysiology underlying these phenomena has not been described. In this manuscript, we combine insights from neuropathological, neuropsychological and neuroimaging studies to propose a testable common neural mechanism for visual hallucinations. We propose that 'simple' visual hallucinations arise from disturbances within regions responsible for the primary processing of visual information, however with no further modulation of perceptual content by attention. In contrast, 'complex' visual hallucinations reflect dysfunction within and between the Attentional Control Networks, leading to the inappropriate interpretation of ambiguous percepts. The incorrect information perceived by hallucinators is often differentially interpreted depending on the time-course and the neuroarchitecture underlying the interpretation. Disorders with 'complex' hallucinations without retained insight are proposed to be associated with a reduction in the activity within the Dorsal Attention Network. The review concludes by showing that a variety of pathological processes can ultimately manifest in any of these three categories, depending on the precise location of the impairment.
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Affiliation(s)
- James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia.
| | - Claire O'Callaghan
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia; Neuroscience Research Australia and the University of New South Wales, Sydney, NSW, Australia.
| | - Glenda M Halliday
- Neuroscience Research Australia and the University of New South Wales, Sydney, NSW, Australia.
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia.
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Hallucinations et cécité corticale après un hématome pédonculaire. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Hallucinations and cortical blindness after peduncular hematoma. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Absence of rapid eye movement sleep with hypnopompic visual hallucinations: A possible harbinger of dementia with Lewy bodies? Sleep Med 2013; 14:377-9. [DOI: 10.1016/j.sleep.2013.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/14/2012] [Accepted: 01/04/2013] [Indexed: 11/20/2022]
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Walterfang M, Goh A, Mocellin R, Evans A, Velakoulis D. Peduncular hallucinosis secondary to central pontine myelinolysis. Psychiatry Clin Neurosci 2012; 66:618-21. [PMID: 23252929 DOI: 10.1111/j.1440-1819.2012.02399.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 06/17/2012] [Accepted: 06/20/2012] [Indexed: 11/27/2022]
Abstract
Peduncular hallucinations are generally associated with lesions in the midbrain. They have rarely been associated with central pontine myelinolysis, a condition associated with rapid alterations in serum sodium and chronic alcoholism. Described herein is the case of a 46-year-old man who developed typical peduncular hallucinations, whose imaging demonstrated central pontine myelinolysis. After alcohol cessation and neuroimaging resolution, the patient's hallucinatory phenomena abated.
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Affiliation(s)
- Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia.
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Rocha FL, Caramelli P, Oliveira LC. Complex visual hallucinations and delusional infestation comorbidity. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:553-4. [DOI: 10.1590/s0004-282x2012000700017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Fábio Lopes Rocha
- Instituto de Previdência dos Servidores do Estado de Minas Gerais, Brazil
| | | | - Laura C. Oliveira
- Instituto de Previdência dos Servidores do Estado de Minas Gerais, Brazil
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Bertram K, Williams DR. Visual hallucinations in the differential diagnosis of parkinsonism. J Neurol Neurosurg Psychiatry 2012; 83:448-52. [PMID: 22228724 PMCID: PMC3297805 DOI: 10.1136/jnnp-2011-300980] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 10/04/2011] [Accepted: 10/24/2011] [Indexed: 11/03/2022]
Abstract
Visual hallucinations (VH) occur commonly in Parkinson's disease (PD) and dementia with Lewy bodies (DLB) but are reported much less frequently in other neurodegenerative causes of parkinsonism, such as progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration syndrome. This clinical sign may be helpful when considering the differential diagnosis of patients with parkinsonism. The observation that VH may be specific to Lewy body pathology probably reflects a greater vulnerability of the visual systems to PD and DLB neurodegeneration compared with other diseases. Topographic differences in pathology are probably the major factor producing VH in Lewy body diseases, rather than neurophysiological changes that are specific to α-synuclein protein accumulation. VH correlate with pathology in the limbic system and more specifically the amygdale that is frequently affected in PD and DLB but relatively preserved in other forms of parkinsonism often misdiagnosed as PD. In this review, the published frequencies of VH in these different conditions are compared to put into context the notion of VH as a clinical clue to underlying Lewy body pathology.
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Affiliation(s)
- Kelly Bertram
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia
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26
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Spiegel D, Barber J, Somova M. A Potential Case of Peduncular Hallucinosis Treated Successfully with Olanzapine. ACTA ACUST UNITED AC 2011; 5:50-3. [DOI: 10.3371/csrp.5.1.7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kester EM. Charles Bonnet syndrome: Case presentation and literature review. ACTA ACUST UNITED AC 2009; 80:360-6. [PMID: 19545849 DOI: 10.1016/j.optm.2008.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 08/28/2008] [Accepted: 10/24/2008] [Indexed: 10/20/2022]
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Mocellin R, Walterfang M, Velakoulis D. Musical hallucinosis: case reports and possible neurobiological models. Acta Neuropsychiatr 2008; 20:91-5. [PMID: 25385469 DOI: 10.1111/j.1601-5215.2007.00255.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The perception of music without a stimulus, or musical hallucination, is reported in both organic and psychiatric disorders. It is most frequently described in the elderly with associated hearing loss and accompanied by some degree of insight. In this setting it is often referred to as 'musical hallucinosis'. The aim of the authors was to present examples of this syndrome and review the current understanding of its neurobiological basis. METHOD We describe three cases of persons experiencing musical hallucinosis in the context of hearing deficits with varying degrees of associated central nervous system abnormalities. RESULTS Putative neurobiological mechanisms, in particular those involving de-afferentation of a complex auditory recognition system by complete or partial deafness, are discussed in the light of current information from the literature. CONCLUSION Musical hallucinosis can be experienced in those patients with hearing impairment and is phenomenologically distinct for hallucinations described in psychiatric disorders.
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Affiliation(s)
- Ramon Mocellin
- 1Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia
| | - Mark Walterfang
- 1Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- 1Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia
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Walterfang M, Yerra R, Gaillard F, O'Brien T, Mocellin R, Velakoulis D. Complex visual hallucinations and occipital seizures. Acta Neuropsychiatr 2007; 19:376-9. [PMID: 26953004 DOI: 10.1111/j.1601-5215.2007.00238.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We describe the presentation of a young woman with long-standing complex partial seizures with occasional secondary generalization, who presented with complex visual hallucinations (CVHs) and delusions. METHODS Routine biological workup including magnetic resonance imaging revealed an area of significant left-sided occipital gliosis. Video telemetry monitoring revealed a left occipital focus for the origin of the electrographic seizure discharge. CONCLUSION CVHs occur in a range of organic states, including epilepsy, and can be understood in terms of the underpinning neuroanatomy and neurotransmitter systems of the visual system.
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Affiliation(s)
- Mark Walterfang
- 1Neuropsychiatry Unit, Royal Melbourne Hospital, Victoria, Australia
| | - Raju Yerra
- 3Department of Neurosciences, Royal Melbourne Hospital, Victoria, Australia
| | | | - Terence O'Brien
- 3Department of Neurosciences, Royal Melbourne Hospital, Victoria, Australia
| | - Ramon Mocellin
- 1Neuropsychiatry Unit, Royal Melbourne Hospital, Victoria, Australia
| | - Dennis Velakoulis
- 1Neuropsychiatry Unit, Royal Melbourne Hospital, Victoria, Australia
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Abstract
BACKGROUND In consultation-liaison settings, neuropsychiatrists are commonly asked to assess patients with hallucinatory syndromes and to differentiate 'functional' from 'organic' psychotic presentations. METHODS The occurrence and management of visual hallucinations (VH) in healthy individuals, lesion states, neurodegenerative disorders, intoxication/withdrawal states and delirium are reviewed. RESULTS The presence of VH has been shown to predict a secondary rather than primary psychotic illness and an understanding of the neurobiology of the visual system - including how and where underlying neurotransmitter systems interact in visual processing and how perturbations can result in VH - allows for appropriate clinical assessment and management.
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Affiliation(s)
- Mark Walterfang
- 1Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Ramon Mocellin
- 1Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Dennis Velakoulis
- 1Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
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