Visual hallucinations in patients with acute stroke: a prospective exploratory study.
The incidence, underlying physiopathology, features and association with lesion topography of visual hallucinations in acute stroke have scarcely been investigated.



Patients with a diagnosis of acute stroke (ischaemic or haemorrhagic) in any vascular territory, admitted within 24 h after the onset of symptoms, were consecutively included in the study. Patients with a previous history of psychosis or cognitive impairment were excluded. They and/or their caregivers answered a structured hallucination and sleep questionnaire at admission, within the first 15 days and at the clinical follow-up 3-6 months after discharge. Lesion location (IMAIOS online atlas) and leukoaraiosis (Wahlund scale) were determined by magnetic resonance imaging or computed tomography scan. Subsets of patients also underwent a neuropsychological evaluation (N = 50) and an electroencephalogram (N = 33) before discharge.



In all, 77 patients with a mean age of 71 ± 12 years were included of whom 57.1% were men. The incidence of visual hallucinations was 16.7%. These hallucinations were mostly complex, in black and white and self-limited. The appearance of hallucinations was not influenced by age, sex, neuropsychological performance during admission or modified Rankin scale score at discharge. Visual hallucinations were associated with occipital cortex lesions (P = 0.04), and with sleep disturbances during and before admission (P = 0.041 and P = 0.03 respectively).



Visual hallucinations are relatively frequent in patients with acute stroke and they are self-limited. Patients with occipital lesions and sleep disturbances are more likely to suffer them.
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
E
E
Morenas-Rodríguez
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
P
P
Camps-Renom
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
A
A
Pérez-Cordón
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
A
A
Horta-Barba
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
M
M
Simón-Talero
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
E
E
Cortés-Vicente
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
D
D
Guisado-Alonso
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
E
E
Vilaplana
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
C
C
García-Sánchez
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
A
A
Gironell
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
C
C
Roig
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
R
R
Delgado-Mederos
Department of Neurology, Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.
J
J
Martí-Fàbregas
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006212:Hallucinations / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000209:etiology / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
acute stroke; hallucinations; hallucinosis; peduncular hallucinosis; perception disturbances; psychosis; stroke; visual hallucinations