Skip to main content

Poststroke Illusions and Hallucinations

  • Chapter
  • First Online:
Neuropsychiatric Symptoms of Cerebrovascular Diseases

Part of the book series: Neuropsychiatric Symptoms of Neurological Disease ((NSND))

Abstract

Illusions are misperceptions or perceptual distortions of an existing external stimulus, and hallucination is a perception in the absence of a stimulus. Both phenomena can occur in the course of a large number of cerebrovascular pathological processes, and they may develop in either isolated or combined modalities. Isolated auditory, olfactory, and tactile hallucinations are a rare event and have been associated with a number of stroke subtypes. Charles-Bonnet syndrome is characterized by the occurrence of visual hallucinations that are formed, complex, persistent or repetitive, and stereotyped; fully or partially retained insight; and absent delusions. Peduncular hallucinosis may develop following rostral brainstem lesion and characterized by seeing animals of bizarre appearance, transformation of the animals into human figures, mobile and multiple-colored images, and visuotactile associations. Isolated or combination of visual and auditory hallucinations following multi-infarct dementia with lesions involving occipitotemporal regions may occasionally occur. In most of the patients, auditory hallucinations were observed mostly after ischemic and hemorrhagic stroke involving posterior parts of the cerebral hemisphere and more frequently in the right than in the left. Patients with syncope and transient cerebral hypoxia may experience visual and auditory hallucinations such as gray haze, colored patches, or bright lights consisting of rushing or roaring noises, screaming, or voices.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hécaen H, Albert M. Human neuropsychology. New York: Wiley; 1978.

    Google Scholar 

  2. Esquirol JED. Les maladies mentales. Paris: Ballieres: 1814. Mental malady. New York: Hafner Press; 1965.

    Google Scholar 

  3. Starkstein SE, Robinson RG, Berthier ML. Post-stroke hallucinatory delusional syndromes. Neuropsychiatry Neuropsychol Behav Neurol. 1992;5:114–8.

    Google Scholar 

  4. Teunisse RJ, Cruysberg JR, Verbeek AL, Zitman FG. The Charles Bonnet syndrome: a large prospective study in the Netherlands: a study of the prevalence of the Charles Bonnet syndrome and associated factors in 500 patients attending the University Department of Ophthalmology at Nijmegen. Br J Psychiatry. 1995;166:254–7.

    Article  PubMed  CAS  Google Scholar 

  5. Sonnenblick M, Nesher R, Rozenman Y, Nesher G. Charles Bonnet syndrome in temporal arteritis. J Rheumatol. 1995;22:1596–7.

    PubMed  CAS  Google Scholar 

  6. de Morsier G. Le syndrome de Charles Bonnet: hallucinations visuelles des vieillards sans deficience mentale (in French). Ann Med Psychol. 1967;125:677–701.

    Google Scholar 

  7. Kolmel HW. Complex visual hallucinations in the hemianopic field. J Neurol Neurosurg Psychiatry. 1985;48:29–38.

    Article  PubMed  CAS  Google Scholar 

  8. Siatkowski RM, Zimmer B, Rosenberg PR. The Charles Bonnet syndrome: visual perceptive dysfunction in sensory deprivation. J Clin Neuroophthalmol. 1990;10:215–8.

    PubMed  CAS  Google Scholar 

  9. Schultz G, Melzack R. The Charles Bonnet syndrome: phantom visual images. Perception. 1991;20:809–25.

    Article  PubMed  CAS  Google Scholar 

  10. Mewasingh LD, Kornreich C, Christiaens F, Christophe C, Dan B. Pediatric phantom vision (Charles Bonnet) syndrome. Pediatr Neurol. 2002;26:143–5.

    Article  PubMed  Google Scholar 

  11. Beniczky S, Keri S, Voros E, et al. Complex hallucinations following occipital lobe damage. Eur J Neurol. 2002;9:175–6.

    Article  PubMed  Google Scholar 

  12. Kurata A, Miyasaka Y, Yoshida T, Kunii M, Yada K, Kan S. Venous ischemia caused by dural arteriovenous malformation: case report. J Neurosurg. 1994;80:552–5.

    Article  PubMed  CAS  Google Scholar 

  13. Adachi N, Watanabe T, Matsuda H, Onuma T. Hyperperfusion in the lateral temporal cortex, the striatum and the thalamus during complex visual hallucinations: single photon emission computed tomography findings in patients with Charles Bonnet syndrome. Psychiatry Clin Neurosci. 2000;54:157–62.

    Article  PubMed  CAS  Google Scholar 

  14. L’Hermitte J. Syndrome de la calotte du pédoncle cérébral. Les troubles psycho-sensorieles dans les lésions du mesencéphale. Rev Neurol. 1922;38:1359–65.

    Google Scholar 

  15. Van Bogaert L. Syndrome inférieur du noyau rouge, troubles psycho-sensoriels d’origine mésocéphalique. Rev Neurol. 1924;40:417–23.

    Google Scholar 

  16. De Morsier G. Les hallucinations visuelles dans les lésions du diencéphale (section 2). Revue Neuro-Oto Ophtalmologie. 1938;16:244–352.

    Google Scholar 

  17. Feinberg WM, Rapcsak SZ. Peduncular hallucinosis after paramedian thalamic infarction. Neurology. 1989;39:1535–6.

    Article  PubMed  CAS  Google Scholar 

  18. McKee AC, Levine DN, Kowall NW, Richardson EP. Peduncular hallucinosis associated with isolated infarction of the substantia pars reticulata. Ann Neurol. 1990;27:500–4.

    Article  PubMed  CAS  Google Scholar 

  19. Manford M, Andermann F. Complex visual hallucinations. Clinical and neurobiological insights. Brain. 1998;121:1819–40.

    Article  PubMed  Google Scholar 

  20. Caplan LR. Top of the basilar syndrome. Neurology. 1980;30:72.

    Article  PubMed  CAS  Google Scholar 

  21. Noda S, Mizoguchi M, Yamamoto A. Thalamic experiential hallucinosis. J Neurol Neurosurg Psychiatry. 1993;56:1224–6.

    Article  PubMed  CAS  Google Scholar 

  22. Catafau JS, Rubio F, Seera JP. Peduncular hallucinosis associated with posterior thalamic infarction. J Neurol. 1992;239:89–90.

    Article  Google Scholar 

  23. Fisher CM. The pathologic and clinical aspects of thalamic hemorrhage. Trans Am Neurol Assoc. 1959;84:56–9.

    PubMed  CAS  Google Scholar 

  24. Santhouse AM, Howard RJ, ffyttche DH. Visual hallucinatory syndromes and the anatomy of the visual brain. Brain. 2000;123:2055–64.

    Article  PubMed  Google Scholar 

  25. Brust JCM, Behrens MM. Release hallucinations as the major symptom of posterior cerebral artery occlusion: a report of 2 cases. Ann Neurol. 1977;2:432–6.

    Article  PubMed  CAS  Google Scholar 

  26. Critchley M. The parietal lobes. London: Edward Arnold; 1953.

    Google Scholar 

  27. Kinsbourne M, Warrington EK. A study of visual perseveration. J Neurol Neurosurg Psychiatry. 1963;26:468–75.

    Article  PubMed  CAS  Google Scholar 

  28. Caplan LR. Posterior cerebral artery syndromes. In: Toole JF, editor. Handbook of clinical neurology. Vascular diseases. Part I, vol. 9(53). Netherlands: Elsevier Science BV; 1988.

    Google Scholar 

  29. Kupersmith MJ, Berenstein A, Nelson PK, Simon HT, Setton A. Visual symptoms with dural arteriovenous malformations draining into occipital veins. Neurology. 1999;52:156–62.

    Article  PubMed  CAS  Google Scholar 

  30. Meadows JC, Munro SS. Palinopsia. J Neurol Neurosurg Psychiatry. 1977;40:5–8.

    Article  PubMed  CAS  Google Scholar 

  31. Michel EM, Troost BT. Palinopsia. Cerebral localization with computed tomography. Neurology. 1980;30:887–9.

    Article  PubMed  CAS  Google Scholar 

  32. Hayashi R, Shimizu S, Watanabe R, Katsumata Y, Mimura M. Palinopsia and perilesional hyperperfusion following subcortical hemorrhage. Acta Neurol Scand. 2002;105:228–31.

    Article  PubMed  CAS  Google Scholar 

  33. Yamada A, Miki H, Nishioka M. A case of posterior cerebral artery territory infarction with micropsia as the chief complaint. Rinsho Shinkeigaku. 1990;30:894–7.

    PubMed  Google Scholar 

  34. Cohen L, Gray F, Meyrignac C. Selective deficit of visual size perception: Two cases of hemimicropsia. J Neurol Neurosurg Psychiatry. 1994;57:73–8.

    Article  PubMed  CAS  Google Scholar 

  35. Critchley MK. Acquired anomalies of color perception of central origin. Brain. 1965;88:711–24.

    Article  PubMed  CAS  Google Scholar 

  36. Pearlman AL, Birch J, Meadows JC. Cerebral color blindness: an acquired defect in hue discrimination. Ann Neurol. 1978;5:253–61.

    Article  Google Scholar 

  37. Damasio A, Yamada Y, Damasio H, Corbett J, MacKee J. Central achromatopsia: behavioral, anatomic, and physiological aspects. Neurology. 1980;30:1064–71.

    Article  PubMed  CAS  Google Scholar 

  38. Meadows JC. Disturbed perception of colours associated with localized cerebral lesions. Brain. 1974;97:615–32.

    Article  PubMed  CAS  Google Scholar 

  39. Polyak SL. The vertebrate visual system. Chicago: University of Chicago Press; 1957.

    Google Scholar 

  40. Mohr JP, Leicester J, Stoddard LT, Sidman M. Right hemianopia with memory and color deficits in circumscribed left posterior cerebral artery territory infarction. Neurology. 1971;21:1104–11.

    Article  PubMed  CAS  Google Scholar 

  41. Geschwind N, Fusillo M. Color-naming defects in association with alexia. Arch Neurol. 1965;15:137–46.

    Article  Google Scholar 

  42. Lipowski ZJ. Delirium: acute confusional states. New York: Oxford University Press; 1990.

    Google Scholar 

  43. Cummings JL, Mega MS. Neuropsychiatry and behavioral neuroscience. Oxford: Oxford University Press; 2003. p. 187–99.

    Google Scholar 

  44. Dening RE, Brrios GE. Autoscopic phenomena. Br J Psychiatry. 1994;165:808–17.

    Article  PubMed  CAS  Google Scholar 

  45. Lhermitte J. Visual hallucinations of the self. BMJ. 1951;1:431–4.

    Article  PubMed  CAS  Google Scholar 

  46. Cummings J, Miller B, Hill MA, Neshkes R. Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Arch Neurol. 1987;44:389–93.

    Article  PubMed  CAS  Google Scholar 

  47. Tonkonogy JM, Puente AE. Localization of clinical syndromes in neuropsychology and neuroscience. New York: Springer; 2009. p. 187–220.

    Google Scholar 

  48. Lance JW. Simple formed hallucinations confined to the area of a specific visual field defect. Brain. 1976;99:719–34.

    Article  PubMed  CAS  Google Scholar 

  49. La Mancusa JC, Cole AR. Visual manifestations of occipital lobe infarction in three patients on a geriatric psychiatry unit. J Geriatr Psychiatry Neurol. 1988;1:231–4.

    Article  PubMed  Google Scholar 

  50. Foerster O. The cerebral cortex in man. Lancet. 1931;2:309–31.

    Google Scholar 

  51. Penfield W, Jasper H. Epilepsy and functional anatomy of the human brain. Boston: Little, Brown; 1954.

    Google Scholar 

  52. West LJ. Hallucinations. New York: Grune and Stratton; 1962.

    Google Scholar 

  53. Lampl Y, Lorberboym M, Gilad R, Boaz M, Sadeh M. Auditory hallucinations in acute stroke. Behav Neurol. 2005;16:211–6.

    PubMed  Google Scholar 

  54. Boyd JG, Jin AY. “Alien voice” auditory hallucinations as the presenting symptom of acute left middle cerebral artery (MCA) infarction. Stroke. 2010;41:e473–510.

    Article  Google Scholar 

  55. Levine DN, Finkelstein S. Delayed psychosis after right temporoparietal stroke and trauma: relation to epilepsy. Neurology. 1982;32:267–73.

    Article  PubMed  CAS  Google Scholar 

  56. Shiga K, Makino M, Ueda Y, Nakajima K. Metamorphopsia and visual hallucinations restricted to the right visual hemifield after a left putaminal haemorrhage. J Neurol Neurosurg Psychiatry. 1996;61:420–1.

    Article  PubMed  CAS  Google Scholar 

  57. Peroutka SJ, Sohmer B, Kumar AJ, Folstein M, Robinson RG. Hallucinations and delusions following a right temporooccipital infarction. Johns Hopkins Med J. 1982;151:181–5.

    PubMed  CAS  Google Scholar 

  58. Murata S, Naritomi H, Sawada T. Musical auditory hallucinations by a brainstem lesion. Neurology. 1994;44:154–8.

    Article  Google Scholar 

  59. Evers S, Ellger T. The clinical spectrum of musical hallucinations. J Neurol Sci. 2004;227:55–65.

    Article  PubMed  Google Scholar 

  60. Ozsarac M, Aksay E, Kiyan S, Unek O, Gulec FF. De novo cerebral arteriovenous malformation: Pink Floyd’s song ‘Brick in the Wall’ as a warning sign. J Emerg Med. 2012;43(1):e17–20. doi:10.1016/j.jemermed.2009.05.035. ISSN 0736–4679.

    Article  PubMed  Google Scholar 

  61. Lanska DJ, Lanska MJ, Mendez M. Brainstem auditory hallucinosis. Neurology. 1987;37:1685.

    Article  PubMed  CAS  Google Scholar 

  62. Cascino GD, Adams RD. Brainstem auditory hallucinosis. Neurology. 1986;36:1042–7.

    Article  PubMed  CAS  Google Scholar 

  63. Hoffman RE, Hampson M, Wu K, Anderson AW, Gore JC, Buchanan RJ, et al. Probing the pathophysiology of auditory/verbal hallucinations by combining functional magnetic resonance imaging and transcranial magnetic stimulation. Cereb Cortex. 2007;17:2733–43.

    Article  PubMed  Google Scholar 

  64. Sommer IE, Diederen KM, Blom JD, Willems A, Kushan L, Slotema K, et al. Auditory verbal hallucinations predominantly activate the right inferior frontal area. Brain. 2008;131:3169–77.

    Article  PubMed  Google Scholar 

  65. Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol. 1994;36:233–7.

    Article  PubMed  CAS  Google Scholar 

  66. Malone GL, Leiman HI. Differential diagnosis of palinacousis in a psychiatric patient. Am J Psychiatry. 1983;140:1067–8.

    PubMed  CAS  Google Scholar 

  67. Feder R. Auditory hallucinations treated by radio headphones. Am J Psychiatry. 1982;139:1188–90.

    PubMed  CAS  Google Scholar 

  68. Berrios GE. Tactile hallucinations: conceptual and historical aspects. J Neurol Neurosurg Psychiatry. 1982;45:285–93.

    Article  PubMed  CAS  Google Scholar 

  69. Halligan PW, Marshall JC, Ramachandran VS. Ghosts in the machine: a case description of visual and haptic hallucinations after right hemisphere stroke. Cogn Neuropsychol. 1994;11:459–77.

    Article  Google Scholar 

  70. Bonda E, Petrides M, Evans A. Neural systems for tactual memories. J Neurophysiol. 1996;75:1730–7.

    PubMed  CAS  Google Scholar 

  71. Gallace A, Spence C. The cognitive and neural correlates of tactile memory. Psychol Bull. 2009;135:380–406.

    Article  PubMed  Google Scholar 

  72. Nagaratnam N, O’Neile L. Delusional parasitosis following occipito-temporal cerebral infarction [letter]. Gen Hosp Psychiatry. 2000;22:129–32.

    Article  PubMed  CAS  Google Scholar 

  73. Adunsky A. Early post-stroke parasitic delusions. Age Ageing. 1997;26:238–9.

    Article  PubMed  CAS  Google Scholar 

  74. Blasco-Fontecilla H, Bragado Jimenez MD, Garcia Santos LM, Barjau Romero JM. Delusional disorder with delusions of parasitosis and jealousy after stroke: treatment with quetiapine and sertraline. J Clin Psychopharmacol. 2005;25:615–7.

    Article  PubMed  Google Scholar 

  75. Huber M, Karner M, Kirchler E, Lepping P, Freudenmann RW. Striatal lesions in delusional parasitosis revealed by magnetic resonance imaging. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1967–71.

    Article  PubMed  Google Scholar 

  76. Halligan PW, Marshall JC, Wade DT. Three arms: a case study of supernumerary phantom limb after right hemisphere stroke. J Neurol Neurosurg Psychiatry. 1993;56:159–66.

    Article  PubMed  CAS  Google Scholar 

  77. Hari R, Karhu J, Hamalainen M, Knuutila J, Salonen O, Sams M, Vilkman V. Functional organization of the human first and second somatosensory cortices: a neuromagnetic study. Eur J Neurosci. 1993;5:724–34.

    Article  PubMed  CAS  Google Scholar 

  78. Perren F, Chabwine JN, Vargas MI, Aboulaffia T, Caratsch L, Schnider A, Landis T. Simultaneous Doppelgänger and limb amputation impression in right frontal opercular stroke. J Neurol Neurosurg Psychiatry. 2011;82:1209–11.

    Article  PubMed  Google Scholar 

  79. Zampini M, Moro V, Aglioti SM. Illusory movements of the contralesional hand in patients with body image disorders. J Neurol Neurosurg Psychiatry. 2004;75:1626–8.

    Article  PubMed  CAS  Google Scholar 

  80. Barra J, Chauvineau V, Ohlmann T, Gresty M, Pérennou D. Perception of longitudinal body axis in patients with stroke: a pilot study. J Neurol Neurosurg Psychiatry. 2007;78:43–8.

    Article  PubMed  CAS  Google Scholar 

  81. Nye E, Arendts G. Intracerebral haemorrhage presenting as olfactory hallucinations. Emerg Med (Fremantle). 2002;14:447–9.

    Article  Google Scholar 

  82. Mizobuchi M, Ito N, Tanaka C, Sako K, Sumi Y, Sasaki T. Unidirectional olfactory hallucination associated with ipsilateral unruptured intracranial aneurysm. Epilepsia. 1999;40:516–9.

    Article  PubMed  CAS  Google Scholar 

  83. Hausser-Hauw C, Bancaud J. Gustatory hallucinations in epileptic seizures: electrophysiological, clinical and anatomical correlates. Brain. 1987;110:339–59.

    Article  PubMed  Google Scholar 

  84. Landis BN, Leuchter I, San Millán Ruíz D, Landis T. Transient hemiageusia in cerebrovascular lateral pontine lesions. J Neurol Neurosurg Psychiatry. 2006;77:680–3.

    Article  PubMed  CAS  Google Scholar 

  85. Heckmann JG, Stössel C, Lang CJ, Bernhard G, Neundörfer B, Tomandl B, Hummel T. Taste disorders in acute stroke. A prospective observational study on taste disorders in 102 stroke patients. Stroke. 2005;36:1690–4.

    Article  PubMed  Google Scholar 

  86. Sanchez-Juan P, Combarros O. Gustatory nervous pathway syndromes. Neurologia. 2001;16:262–71.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emre Kumral MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Kumral, E. (2013). Poststroke Illusions and Hallucinations. In: Ferro, J. (eds) Neuropsychiatric Symptoms of Cerebrovascular Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2428-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2428-3_2

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2427-6

  • Online ISBN: 978-1-4471-2428-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics