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Abstract

Visual Hallucinations with Disembodiment and Self-Motion Illusion on Eye Closure after Brain Cyst Drainage: A Case Report

Author(s): Anna Sontheimer, Guillaume Coll, Sophie Mathais, François Vassal, Jean Jacques Lemaire

Background

We report the first documented case of visual hallucinations with disembodiment and selfmotion illusion on eye closure.

Clinical presentation

A 71-year-old woman was operated on for a cyst of the left centrum semiovale, adjacent to the precuneus, the posterior cingulate cortex and the splenium of corpus callosum. Two days after, she complained of visual hallucinations occurring on eye closure. She reported reminiscences of landscapes, trees and animals. She had a sensation of floating and moving, flying over the landscapes or walking on lanes. She could stop the hallucinations by opening her eyes. The hallucinations lasted for six days. Pharmacological and neurological possible origins of the hallucinations were explored.

Conclusion

No direct relation could be found between the pharmacological treatment and the hallucinations. Cerebral volumetric analysis showed a structural reorganization following cyst drainage, which might have conducted to transient hyper excitability of the surrounding structures. The release phenomenon induced by eye closure might have triggered the activation of a distributed network within associative visual, parietal and temporal cortices. The involvement of the splenium and the cingulum is discussed. Furthermore, MRI- and DTI-follow-up suggests that structural reorganization after surgery can be spread over long periods until disappearance of cyst-related deformations. Stabilization of cyst volume, near to zero, was observed after about 2 years.


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