University of Michigan, Department of Emergency Medicine, B1-380 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America.
St. Joseph's Mercy Hospital Ann Arbor, Department of Emergency Medicine, 5305 East Huron River Drive, Ann Arbor, MI 48106, United States of America.
Am J Emerg Med. 2022 Jul;57:237.e1-237.e3. doi: 10.1016/j.ajem.2022.04.040. Epub 2022 Apr 30.
Visual hallucinations are visual perceptions that are not associated with a real object. Visual hallucinations are often associated with dementia, eye disease, visual pathway disease, psychiatric disorders, delirium, migraines, ictal phenomena, or medication effects. We report a case of a 74-year-old woman with a previous cerebrovascular accident(CVA) without residual deficit and no previous psychiatric history presenting for one week of worsening hallucinations progressing from shapes to cats to human figures in the left visual field. She had no focal neurologic deficits nor visual field defects detected on physical exam. CT head without intravenous(IV) contrast demonstrated a nonspecific hypodensity in the right parieto-occipital region. MRI brain with and without IV contrast confirmed an acute stroke. Patient was admitted for risk factor modification and secondary prevention. She continues to have infrequent hallucinations of floating hands and fingers at follow-up appointment 2 weeks after the initial presentation to the Emergency Department. Posterior circulation CVAs can present with subtle or unusual symptoms. CVA should be included in the differential for new onset hallucinations, particularly in elderly patients.
视觉幻觉是指与真实物体无关的视觉感知。视觉幻觉通常与痴呆、眼病、视觉通路疾病、精神障碍、谵妄、偏头痛、发作现象或药物作用有关。我们报告了一例 74 岁女性病例，该患者曾发生过无残留缺陷的脑血管意外（CVA），且无既往精神病史，出现一周的幻觉恶化，从形状到猫再到左视野中的人形。她在体检时既没有发现局灶性神经功能缺损，也没有发现视野缺陷。头部 CT 平扫未见静脉（IV）对比显示右顶枕叶区域存在非特异性低密区。MRI 脑平扫+IV 对比证实为急性中风。患者因危险因素改变和二级预防而入院。在最初到急诊科就诊 2 周后的随访预约中，她仍偶尔会出现漂浮的手和手指的幻觉。后循环 CVA 可表现出微妙或不寻常的症状。对于新发的幻觉，特别是老年患者，应将 CVA 纳入鉴别诊断。
