Positive visual phenomena

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Lesions in the visual pathway affect vision most often by creating deficits or negative phenomena, such as blindness, visual field deficits or scotomas, decreased visual acuity and color blindness. On occasion, they may also create false visual images, called positive visual phenomena. These images can be a result of distortion of incoming sensory information leading to an incorrect perception of a real image called an illusion. When the visual system produces images which are not based on sensory input, they can be referred to as hallucinations. The visual phenomena may last from brief moments to several hours, but they also can be permanent. They are generally associated with other symptoms but occasionally are isolated. Conditions causing these phenomena include disruptions in the visual input along the pathways (retina, optic nerve, chiasmal and retrochiasmal lesions) lesions in the extracortical visual system, migraines, seizures, toxic-metabolic encephalopathy, psychiatric conditions and sleep apnea, among others. The mechanisms underlying positive visual phenomena are not yet well understood. Possible mechanisms may be: 1) defect in the sensory input causing compensatory upregulation of the visual cortex, 2) faulty visual processing in which inputs are normal but lesions result in an inappropriate pattern of cortical excitation, 3)variants of normal visual processing. Of all forms of hallucination, visual hallucinations are the least likely to be associated with psychiatric disorders. For example most patients with visual hallucinations do not have schizophrenia and most patients with schizophrenia do not have visual hallucinations.

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Classification

Illusions

As described above, illusions can consist in a misinterpretation of a real sensory input, such as a recurrence, persistence, duplication or change in the size of images.

Palinopsia

A persistence of a visual image of an object in time after the actual object has disappeared. There are two forms of palinopsia, an immediate and a delayed type. In the immediate type the image continually persists in the visual field after actually disappearing. On the other hand, in the delayed type, the image reappears after an interval of minutes to hours after disappearing. The pathophysiology of palinopsia remains unclear. The immediate type may be an exaggeration of the afterimage whereas the delayed type may indicate that there is cerebral involvement, such as an ictal manifestation or a structural lesion, but has also been shown to be inducible by drugs. The differential diagnosis includes toxins, metabolic disorders and psychiatric conditions.

Polyopia

A rare illusion characterized by monocular diplopia, excluding refractive abnormalities. When this occurs at the cortical level, this pathophysiology is not well understood.

Dysmetropsia (Micro/Macropsia)

The illusion that objects are smaller/larger than in reality. Retinal dysmetropsia is the most common type; however, migraine related dysmetropsia may be more common than appreciated. Unusual causes include cortex lesions and seizures.

Metamorphopsia

The illusion that objects are distorted. As in dysmetropsia, the retinal methamorphopsia is the more common type, although it has been described with seizures and temporo-occipital lesions.

Hallucinations

Hallucination is defined as visual perception without external stimulation. It must be distinguished whether the individual is able to recognize that the perception is not real, also called pseudo-hallucination, or that the individual endorses it as real, also called delusion. It is only delusion that has serious psychiatric implications. The content of hallucinations is widely variable and can range from simple images including flashing or steady spots, colored lines and shapes (unformed hallucinations) to vivid objects, flowers, animals and persons (formed hallucinations). The differential diagnosis includes entopic phenomena, which are visual images produced within the eye and reflected to the retina. Frequent causes of hallucination include release phenomena (due to impairment of vision) such as Charles Bonnet Syndrome.

Related Research Articles

Hallucination Perception in the absence of external stimulation that has the qualities of real perception

A hallucination is a perception in the absence of external stimulus that has qualities of real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and imagery (imagination), which does not mimic real perception and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.

Optical illusion Visually perceived images that differ from objective reality

An optical illusion is an illusion caused by the visual system and characterized by a visual percept that arguably appears to differ from reality. Illusions come in a wide variety; their categorization is difficult because the underlying cause is often not clear but a classification proposed by Richard Gregory is useful as an orientation. According to that, there are three main classes: physical, physiological, and cognitive illusions, and in each class there are four kinds: Ambiguities, distortions, paradoxes, and fictions. A classical example for a physical distortion would be the apparent bending of a stick half immerged in water; an example for a physiological paradox is the motion aftereffect. An example for a physiological fiction is an afterimage. Three typical cognitive distortions are the Ponzo, Poggendorff, and Müller-Lyer illusion. Physical illusions are caused by the physical environment, e.g. by the optical properties of water. Physiological illusions arise in the eye or the visual pathway, e.g. from the effects of excessive stimulation of a specific receptor type. Cognitive visual illusions are the result of unconscious inferences and are perhaps those most widely known.

Micropsia condition

Micropsia is a condition affecting human visual perception in which objects are perceived to be smaller than they actually are. Micropsia can be caused by optical factors, by distortion of images in the eye, by changes in the brain, and from psychological factors. Dissociative phenomena are linked with micropsia, which may be the result of brain-lateralization disturbance.

Alice in Wonderland syndrome disorienting neurological condition

Alice in Wonderland syndrome (AIWS), also known as Todd's syndrome or dysmetropsia, is a neuropsychological condition that causes a distortion of perception. People may experience distortions in visual perception of objects such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) away than they actually are. Distortion may occur for other senses besides vision as well.

Macropsia is a neurological condition affecting human visual perception, in which objects within an affected section of the visual field appear larger than normal, causing the person to feel smaller than they actually are. Macropsia, along with its opposite condition, micropsia, can be categorized under dysmetropsia. Macropsia is related to other conditions dealing with visual perception, such as aniseikonia and Alice in Wonderland Syndrome. Macropsia has a wide range of causes, from prescription and illicit drugs, to migraines and (rarely) complex partial epilepsy, and to different retinal conditions, such as epiretinal membrane. Physiologically, retinal macropsia results from the compression of cones in the eye. It is the compression of receptor distribution that results in greater stimulation and thus a larger perceived image of an object.

Occipital lobe part of the brain

The occipital lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The occipital lobe is the visual processing center of the mammalian brain containing most of the anatomical region of the visual cortex. The primary visual cortex is Brodmann area 17, commonly called V1. Human V1 is located on the medial side of the occipital lobe within the calcarine sulcus; the full extent of V1 often continues onto the occipital pole. V1 is often also called striate cortex because it can be identified by a large stripe of myelin, the Stria of Gennari. Visually driven regions outside V1 are called extrastriate cortex. There are many extrastriate regions, and these are specialized for different visual tasks, such as visuospatial processing, color differentiation, and motion perception. The name derives from the overlying occipital bone, which is named from the Latin ob, behind, and caput, the head. Bilateral lesions of the occipital lobe can lead to cortical blindness.

Afterimage perception that continues after stimulus

An afterimage is an image that continues to appear in the eyes after a period of exposure to the original image. An afterimage may be a normal phenomenon or may be pathological (palinopsia). Illusory palinopsia may be a pathological exaggeration of physiological afterimages. Afterimages occur because photochemical activity in the retina continues even when the eyes are no longer experiencing the original stimulus.

Claustrum structure in the brain, gray matter lamina located underneath the inner neocortex

The claustrum is a thin, bilateral structure that connects to cortical and subcortical regions of the brain. It is located between the insula laterally and the putamen medially, separated by the extreme and external capsules respectively. The blood supply to the claustrum is fulfilled via the middle cerebral artery. It is considered to be the most densely connected structure in the brain, allowing for integration of various cortical inputs into one experience rather than singular events. The claustrum is difficult to study given the limited number of individuals with claustral lesions and the poor resolution of neuroimaging.

Visual release hallucinations, also known as Charles Bonnet syndrome or CBS, are a type of psychophysical visual disturbance and the experience of complex visual hallucinations in a person with partial or severe blindness.

Scotoma Human disease

A scotoma is an area of partial alteration in the field of vision consisting of a partially diminished or entirely degenerated visual acuity that is surrounded by a field of normal – or relatively well-preserved – vision.

Entoptic phenomena are visual effects whose source is within the eye itself.

Palinopsia is the persistent recurrence of a visual image after the stimulus has been removed. Palinopsia is not a diagnosis, it is a diverse group of pathological visual symptoms with a wide variety of causes. Visual perseveration is synonymous with palinopsia.

Aura (symptom) perceptual disturbance experienced by some migraine sufferers

An aura is a perceptual disturbance experienced by some with epilepsy or migraine.

Troxlers fading Optical illusion affecting visual perception

Troxler's fading, or Troxler fading, or the Troxler effect, is an optical illusion affecting visual perception. When one fixates on a particular point for even a short period of time, an unchanging stimulus away from the fixation point will fade away and disappear. Recent research suggests that at least some portion of the perceptual phenomena associated with Troxler's fading occurs in the brain.

Photopsia flashes of light

Photopsia is the presence of perceived flashes of light in the field of vision.

An empirical theory of perception is a type of explanation for how percepts form. These theories hold that sensory systems incorporate information about the statistical properties of the natural world into their design and relate incoming stimuli to this information, rather than analyzing sensory stimulation into its components or features.

Illusory palinopsia is a subtype of palinopsia, a visual disturbance defined as the persistence or recurrence of a visual image after the stimulus has been removed. Palinopsia is a broad term describing a heterogeneous group of symptoms, which is divided into hallucinatory palinopsia and illusory palinopsia. Illusory palinopsia is likely due to sustained awareness of a stimulus and is similar to a visual illusion: the distorted perception of a real external stimulus.

Hallucinatory palinopsia is a subtype of palinopsia, a visual disturbance defined as the persistent or recurrence of a visual image after the stimulus has been removed. Palinopsia is a broad term describing a group of symptoms which is divided into hallucinatory palinopsia and illusory palinopsia. Hallucinatory palinopsia refers to the projection of an already-encoded visual memory and is similar to a complex visual hallucination: the creation of a formed visual image where none exists.

Cerebral diplopia or polyopia describes seeing two or more images arranged in ordered rows, columns, or diagonals after fixation on a stimulus. The polyopic images occur monocular bilaterally and binocularly, differentiating it from ocular diplopia or polyopia. The number of duplicated images can range from one to hundreds. Some patients report difficulty in distinguishing the replicated images from the real images, while others report that the false images differ in size, intensity, or color. Cerebral polyopia is sometimes confused with palinopsia, in which multiple images appear while watching an object. However, in cerebral polyopia, the duplicated images are of a stationary object which are perceived even after the object is removed from the visual field. Movement of the original object causes all of the duplicated images to move, or the polyopic images disappear during motion. In palinoptic polyopia, movement causes each polyopic image to leave an image in its wake, creating hundreds of persistent images (entomopia).

Visual hallucinations in psychosis are hallucinations accompanied by delusions, which are abnormal beliefs that are endorsed by patients as real, that persist in spite of evidence to the contrary, and that are not part of a patient's culture or subculture.

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