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May 05, 2020; 94 (18) Article

Neuroanatomic correlates of visual hallucinations in poststroke hemianopic patients

Fiora Martinelli, Céline Perez, Florent Caetta, Michaël Obadia, View ORCID ProfileJulien Savatovsky, Sylvie Chokron
First published April 6, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009366
Fiora Martinelli
From the Institut de Neuropsychologie, Neurovision et Neurocognition (F.M., C.P., F.C., S.C.), Service de Neurologie (M.O.), Unité Neurovasculaire, and Service d'Imagerie (J.S.), Fondation Ophtalmologique Adolphe de Rothschild; and Integrative Neuroscience and Cognition Center (F.C., S.C.), CNRS, UMR 8242 et Université Paris-Descartes, Paris, France.
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Céline Perez
From the Institut de Neuropsychologie, Neurovision et Neurocognition (F.M., C.P., F.C., S.C.), Service de Neurologie (M.O.), Unité Neurovasculaire, and Service d'Imagerie (J.S.), Fondation Ophtalmologique Adolphe de Rothschild; and Integrative Neuroscience and Cognition Center (F.C., S.C.), CNRS, UMR 8242 et Université Paris-Descartes, Paris, France.
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Florent Caetta
From the Institut de Neuropsychologie, Neurovision et Neurocognition (F.M., C.P., F.C., S.C.), Service de Neurologie (M.O.), Unité Neurovasculaire, and Service d'Imagerie (J.S.), Fondation Ophtalmologique Adolphe de Rothschild; and Integrative Neuroscience and Cognition Center (F.C., S.C.), CNRS, UMR 8242 et Université Paris-Descartes, Paris, France.
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Michaël Obadia
From the Institut de Neuropsychologie, Neurovision et Neurocognition (F.M., C.P., F.C., S.C.), Service de Neurologie (M.O.), Unité Neurovasculaire, and Service d'Imagerie (J.S.), Fondation Ophtalmologique Adolphe de Rothschild; and Integrative Neuroscience and Cognition Center (F.C., S.C.), CNRS, UMR 8242 et Université Paris-Descartes, Paris, France.
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Julien Savatovsky
From the Institut de Neuropsychologie, Neurovision et Neurocognition (F.M., C.P., F.C., S.C.), Service de Neurologie (M.O.), Unité Neurovasculaire, and Service d'Imagerie (J.S.), Fondation Ophtalmologique Adolphe de Rothschild; and Integrative Neuroscience and Cognition Center (F.C., S.C.), CNRS, UMR 8242 et Université Paris-Descartes, Paris, France.
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  • ORCID record for Julien Savatovsky
Sylvie Chokron
From the Institut de Neuropsychologie, Neurovision et Neurocognition (F.M., C.P., F.C., S.C.), Service de Neurologie (M.O.), Unité Neurovasculaire, and Service d'Imagerie (J.S.), Fondation Ophtalmologique Adolphe de Rothschild; and Integrative Neuroscience and Cognition Center (F.C., S.C.), CNRS, UMR 8242 et Université Paris-Descartes, Paris, France.
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Neuroanatomic correlates of visual hallucinations in poststroke hemianopic patients
Fiora Martinelli, Céline Perez, Florent Caetta, Michaël Obadia, Julien Savatovsky, Sylvie Chokron
Neurology May 2020, 94 (18) e1885-e1891; DOI: 10.1212/WNL.0000000000009366

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Abstract

Objectives Homonymous hemianopia (HH) is the most frequent visual-field defect after a stroke. Some of these patients also have visual hallucinations, the origin and frequency of which remain largely unknown. The aims of this work were to determine the occurrence of visual hallucinations among poststroke hemianopic patients in function of the location (Brodmann areas) of the brain lesion, as determined by MRI, and to study the neuroanatomic correlates of these hallucinations by nature, frequency, and type.

Methods One hundred sixteen patients with HH who had had a stroke in the posterior region, including the occipital lobe, participated in the study. We evaluated the frequency and nature of visual hallucinations with the Questionnaire for Hallucinations in Homonymous Hemianopia. The volume of each patient's brain lesion was modeled in 3 dimensions.

Results Of 116 patients with an HH from a cortical infarction, 85 were excluded due to confounding factors associated with hallucinations. In the final cohort of 31 patients matched for lesion location and etiology, 58% had experienced hallucinations. A significant inverse correlation between lesion size and the frequency of visual hallucinations emerged. The presence of visual hallucinations in poststroke hemianopic patients requires a relatively small lesion that includes, at the very least, loss of the striate cortex but that spares Brodmann area 19, 20, and 37.

Conclusion Our results suggest that visual hallucinations might be due to complex interactions between damaged areas and intact areas of the visual cortex. We discuss these findings regarding models of perception and of visual recognition. Our results also have implications for the clinical care of patients with HH who have had a stroke.

Glossary

BA=
Brodmann area;
HH=
homonymous hemianopia;
Q3H=
Questionnaire for Hallucinations in Homonymous Hemianopia

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received July 31, 2019.
  • Accepted in final form November 22, 2019.
  • © 2020 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Author response: Neuroanatomic correlates of visual hallucinations in poststroke hemianopic patients
    • Fiora Martinelli, Neuropsychologist, Fondation Ophtalmologique Rothschild
    • Sylvie Chokron, Senior Researcher, CNRS & Fondation Ophtalmologique Rothschild
    Submitted June 05, 2020
  • Reader response: Neuroanatomic correlates of visual hallucinations in poststroke hemianopic patients
    • Michael S. Vaphiades, Physician, University of Alabama at Birmningham
    Submitted May 28, 2020
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