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Palinopsia

Timothy C. Hain, MD Most recent update: September 17, 2016


Palinopsia (Greek: palin for again, and opsia for seeing) is a visual symptom in which images of an object persist or reappear after the person has stopped looking at the object. In many cases patients see a series of echoes of the object. Eye movements may make an object appear to leave a trail. Palinopsia sounds somewhat similar to another rare neurological condition where there are echoing of sounds (palinacusis), but the two disorders are not related. Oscillopsia

Palinopsia is defined as being distinct from a normal physiologic afterimage, such as occurs after a camera flash bulb, but afterimages can be mistaken for palinopsia.

Gersztenkorn and Lee divided Palinopsia into “illusory” and “hallucinatory” (Gersztenkorn & Lee, 2015). The also develop a complex lexicon for variants of palinopsia.

"Hallucinatory palinopsia" describes afterimages that are not usually affected by environmental conditions of light or motion and are long-lasting, isochromatic (single color), and high resolution. These are attributed to "a dysfunction of visual memory and is caused by posterior cortical lesions or seizures".

"Illusory palinopsia" describes afterimages that are unformed, indistinct or of low resolution and are affected by ambient light or motion. These are attibuted to migraine, drugs, or head trauma.

In our opinion, this distinction is not especially helpful, as we don't really see why either "type" of palinopsia might not be reasonably associated with either list of causes.

In addition to just plain palinopsia, there are 8 subcategories of symptoms.

  1. Formed image perservation -- such as seeing a picture of an insect superimposed on vision for seconds to days.
  2. Scene perseveration -- this is similar to a video clip that replays.
  3. Categorical incorporation -- seeing an object and then superimposing it on similar objects. For example, seeing a beard, and seeing other bearded people.
  4. Illusory visual spread -- for example a checkerboard that spreads onto other perseverated objects.
  5. Light streaking -- relative motion between a person and light source causes streaking to appear behind the light. For example, while driving at night.
  6. Visual trailing -- copies left in the wake of a moving object.
  7. Prolonged indistinct afterimage
  8. Variant image perservation -- faded image.

It seems to us that this is quite a bit of splitting, without much useful consequence.

Blom (2016) included palinacusis as one of roughly 50 other visual symptoms in "Alice in wonderland syndrome" or AIWS. Thus Blom split up the central visual pie even more finely. In essence, AIWS consists of perceptual distortions, largely of vision, often involving multiple visual images or perceptual changes of size of body parts. Somewhat like what is ordinarily attributed to certain types of substance abuse. Blom lists diverse sources of AIWS, of which the largest single entity is migraine.

Associated symptoms to palinacusis include:

Reported causes of palinopsia include (according to G and L, 2015):

Other reported causes of palinopsia include visual cortex lesions(Auzou, Ozsancak, Miret, Hitzel, & Hannequin, 1998; Haraldsdottir, Haraldsdottir, & Sveinbjoernsdottir, 2001; Huang, Baskin, & Fung, 2015; Khan et al., 2011; Purvin, Bonnin, & Goodman, 1989; Werring & Marsden, 1999), Migraine (Belcastro et al., 2011; Kalita, Uniyal, & Bhoi, 2016) and certain drugs including Topamax (Haraldsdottir et al., 2001).

In the author's clinical practice, most cases have been attributed to migraine.

Paliopsia and dizziness:

With respect to dizziness, symptoms resembling palinopsia may occur in two contexts:

When the vestibular system is not working well, a head movements, such as from a car on a bumpy road may result in the eye moving with the head, and multiple images. These are a simple physical consequence of inadvertent eye movement, and are in essence an afterimage rather than true palinopsia.

Treatment of Palinopsia

Initially there is an attempt to determine the cause. This normally involves imaging. An EEG may also be helpful. Treatment is directed at the cause.

If no cause is identified, treatment for migraine may be offered.

References:

 

Copyright September 17, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on September 17, 2016