C. Hain, MD • Most recent update:
December 6, 2020
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 repeated images -- visual echos -- of the object. Eye movements to follow an object may 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.
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. Palinopsia often accompanies visual snow.
Gersztenkorn and Lee divided Palinopsia into “illusory” and “hallucinatory” (Gersztenkorn & Lee, 2015). They also developed 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.
- Formed image perservation -- such as seeing a picture of an insect superimposed on vision for seconds to days.
- Scene perseveration -- this is similar to a video clip that replays.
- Categorical incorporation -- seeing an object and then superimposing it on similar objects. For example, seeing a beard, and seeing other bearded people.
- Illusory visual spread -- for example a checkerboard that spreads onto other perseverated objects.
- Light streaking -- relative motion between a person and light source causes streaking to appear behind the light. For example, while driving at night.
- Visual trailing -- copies left in the wake of a moving object.
- Prolonged indistinct afterimage
- Variant image perservation -- faded image.
It seems to us that this is quite a bit of splitting, without much useful consequence.
Blom (2016) included palinaopsia 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 palinaopsia include:
- Cerebral Polyopia is defined by G and L above (2015) as when a patient sees two or more duplicated images arranged in ordered rows or columns after fixation on an object. Not all authors seem to define polyopia as images in columns however. It is also difficult to imagine a mechanism for this to occur.
- Akinetopsia is defined as failure to percieve motion, also called "stroboscopic vision".
- Visual allesthesia occurs when fixation on an object causes its duplication in the opposite hemifield.
- Entopic phenomena are observation of real physiologic processes, such as seeing white blood cells moving through retinal capillaries or tree-like outlines representing the retinal circulation. These may be related to visual hypersensitivity, which is discussed under the category of photophobia.
Reported causes of palinopsia include (according to G and L, 2015):
- Drugs and medications (14 cases of illicit drugs,27 cases from prescription drugs in world literature as of 2015)
- Seizures (6 cases reported)
- Focal cerebral lesions (at least 44 posterior visual pathway lesions reported)
- Psychiatric disease (4 cases in world literature)
- Migraine (6 cases in world literature) -- this seem immensely low to us.
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. This is presumably because migraine is so broadly defined as to include about 15% of the entire population.
Paliopsia and dizziness:
With respect to dizziness, symptoms resembling palinopsia may occur:
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 one can be identified.
If no cause is identified, treatment for migraine may be offered.
- Auzou, P., Ozsancak, C., Miret, N., Hitzel, A., & Hannequin, D. (1998). [Palinopsia associated with partial seizures secondary to right parietal hemorrhage]. Ann Med Interne (Paris), 149(3), 161-163.
- Belcastro, V., Cupini, L. M., Corbelli, I., Pieroni, A., D'Amore, C., Caproni, S., . . . Calabresi, P. (2011). Palinopsia in patients with migraine: a case-control study. Cephalalgia, 31(9), 999-1004. doi:10.1177/0333102411410083
- Blom JD. Alice in wonderland syndrome. Neurology clinical practice review. June, 2016, 259-270
- Fontenelle, L. F. (2008). Topiramate-induced palinopsia. J Neuropsychiatry Clin Neurosci, 20(2), 249-250. doi:10.1176/appi.neuropsych.20.2.249
- Gersztenkorn, D., & Lee, A. G. (2015). Palinopsia revamped: a systematic review of the literature. Surv Ophthalmol, 60(1), 1-35. doi:10.1016/j.survophthal.2014.06.003
- Haraldsdottir, K. H., Haraldsdottir, K., & Sveinbjoernsdottir, S. (2001). [Visual hallucinations and palinopsia in stroke.]. Laeknabladid, 87(4), 299-302.
- Huang, M., Baskin, D. S., & Fung, S. (2015). Glioblastoma Presenting with Pure Alexia and Palinopsia Involving the Left Inferior Occipital Gyrus and Visual Word Form Area Evaluated with Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging Tractography. World Neurosurg. doi:10.1016/j.wneu.2015.12.071
- Kalita, J., Uniyal, R., & Bhoi, S. K. (2016). Is palinopsia in migraineurs an enhanced physiological phenomenon? Cephalalgia. doi:10.1177/0333102415625610
- Khan, A. N., Sharma, R., Khalid, S., McKean, D., Armstrong, R., & Kennard, C. (2011). Palinopsia from a posteriorly placed glioma--an insight into its possible causes. BMJ Case Rep, 2011. doi:10.1136/bcr.08.2010.3273
- Pomeranz HD, Lessell S. Palinopsia and polyopia in the absence of drugs or
cerebral disease. Neurology 2000 54:855-859
- Purvin, V., Bonnin, J., & Goodman, J. (1989). Palinopsia as a presenting manifestation of Creutzfeldt-Jakob disease. J Clin Neuroophthalmol, 9(4), 242-246; discussion 247-248.
- Werring, D. J., & Marsden, C. D. (1999). Visual hallucinations and palinopsia due to an occipital lobe tuberculoma. J Neurol Neurosurg Psychiatry, 66(5), 684.