Seeing Things: Mind or Brain?

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Researchers presented on the multifaceted pathophysiology of visual hallucinations (VH) in a poster presentation at the American Neuropsychiatric Association (ANPA) 23rd Annual Meeting.

In the presentation, researchers from Howard University College of Medicine, Howard University Hospital, and Johns Hopkins School of Medicine stated that the potential connection between VH and psychotic disorders such as schizophrenia is often thought to be underreported and underdiagnosed due to the common association of VH with neurodegenerative conditions such as Parkinson disease and Charles Bonnet syndrome. To illustrate the need for systematic approaches in care for VH as a presenting symptom, the investigators shared the case of a patient aged 77 years with a history of diabetes, atrial fibrillation, and stroke who presented to the emergency department dysarthric, combative, and delirious, with perceptual disturbances and disorganized thinking and behavior.

Following unremarkable results from neurological workup—which included a neurological exam and a head computed tomography (CT) scan—the patient’s VH symptoms were thought to be psychiatric. However, an MRI was performed, which revealed acute infarctions in the left temporal and lower occipital lobes; these results implicated the ventral and dorsal attention networks connected to VH. Following 12 days of conservative management, the patient was discharged post-VH symptom remission.¹

According to the investigators, VH is a transdiagnostic symptom that can be challenging to explore and interpret, especially in cases of VH presenting as an isolated symptom with subtle changes in mental status. As such, ruling out psychiatric and neurological etiologies during evaluation of VH is critical.

The investigators concluded that this case “highlight[s] the need for systematic approaches both diagnostically and phenomenologically to drive multidisciplinary care appropriate for a presenting symptom of VH.”¹

Reference

1. Mani J, Mubbashar I, Oyawusi M, Salpekar J. Seeing things: mind or brain? Poster presentation. Presented at American Neuropsychiatric Association 23rd Annual Meeting. March 16-20, 2022. Accessed March 17, 2022.