||Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX, Professor of Ophthalmology, Weill Cornell Medicine; Priyanka Deshpande, Baylor College of Medicine, Class of 2021
||Summary: Palinopsia is defined as seeing an image repeatedly, or having a persistent recurrence of an image, after the visual stimulus has been removed. From "palin-" meaning "repeat" and "-opsia" meaning "see". • Hallucinatory Palinopsia - seeing an image after the stimulus has been removed from the visual field • Illusory Palinopsia - seeing multiple interpretations/distortions of an image based on a stimulus in the visual field -Pathophysiology: higher-order, cortical-based phenomenon -Work-Up for Diagnosis: • MRI - lesion in occipital lobe or visual association cortex • Visual field exam - check for homonymous hemianopsia indicating structural lesions • EEG - consider for further work-up -Etiology: • Medication side effects. Most common is clomiphene, an infertility drug. • Substance use. Hallucinogens (ex. LSD), even if used in remote past. • Migraines • Seizures -Treatment: • Difficult to treat. • Remove offending agent, if identified. • Anti-migraine or anti-seizure medications. • Reassurance. [Transcript of video] "So, we're going to be talking about palinopsia. "-Opsia" means "see", "palin-" means "repeat". So like palindrome: a man, a plan, a canal, "panama", "racecar", these are palindromes, so it repeats. And when patients have palinopsia, they see a repeat of the same image over and over and over again. So, for example, they might be looking at their hand, and they see their hand over and over and over again, five hands in a row. Or if they see me giving a lecture, they might see me over and over and over again. There can be both a hallucinatory palinopsia where they see an image but not one they're looking at. Or an illusory palinopsia, for example, they're looking at their hand and they see multiple interpretations of their hand. (0:45) Obviously, this is going to be a higher-order, cortical-based phenomenon. It doesn't arise from the eye. And when you hear this palinopsia, you probably should be imaging the patient with an MRI. Usually the lesion is occipital or in the visual association cortex. It can be caused by medicines. The most common medicine to cause it is clomiphene, the drug used for infertility. But other things can cause palinopsia, including any of the hallucinogens. And that can be delayed, so they could have used a hallucinogen like LSD in the remote past like in the ‘70s or in the ‘60s even, and then years later they have it. Migraine can cause it and seizure can cause it. But we need to do an MRI to look at the occipital lobe. You should do a visual field [exam] to see if they have homonymous hemianopsia and make sure there is no structural lesion. It is hard to treat it. Many of the patients benefit from just having reassurance. But we can use anti-seizure medicines and anti-migraine medicines to try to treat the palinopsia, and obviously trying to treat the etiology. (1:48) So, if a patient complains about seeing the same image over and over and over again, that's a repeating image, called a palin-, palinopsia, repeating image over and over again. It can illusory or hallucinatory. You need to do an MRI scan. And consider an EEG during a migraine and getting rid of any potential agents including clomiphene."