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Approach to the patient with visual hallucinations

Author
Victoria S Pelak, MD
Section Editor
Paul W Brazis, MD
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Visual hallucinations are a clinical manifestation of neuroophthalmologic dysfunction resulting from a wide variety of underlying etiologies. They can be very disconcerting to some patients, regardless of their insight, and can significantly decrease quality of life [1].

Familiarity with the disorders associated with visual hallucinations is essential to provide the appropriate care. The history, accompanying symptoms, and clinical signs are important elements for determining the most likely cause. In certain patients, further investigation may be necessary before a definitive cause can be determined.

CLASSIFICATION AND TERMINOLOGY

A visual hallucination is a perception of an external visual stimulus where none exists. In contrast, a visual illusion is a distortion or modification of real external visual stimuli [2]. Examples of visual illusions include distortions of size (micropsia or macropsia), shape (metamorphopsia), and color (dyschromatopsia). Visual hallucinations and illusions are clinically distinct phenomena, but have overlapping etiologies.

One classification scheme divides visual hallucinations into irritative phenomena that result in brief stereotyped hallucinations, and release hallucinations that are continuous and variable [3]. This classification scheme is somewhat limited because the generalizations are not absolute, and some disorders have characteristics of both types. As an example, in migraine, visual hallucinations can be stereotyped and brief, or variable and continuous. Hallucinations associated with peduncular hallucinosis are often brief, but the content tends to be variable and not stereotyped.

A more useful classification scheme categorizes hallucinations as simple or complex [4]:

                

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 06 00:00:00 GMT+00:00 2014.
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