157:, and following regional surgical or angiographic interventions. These pathologies are mainly near the base of the brain and the hallucinations have gone away in patients that had their pathology corrected such as the removal of a tumor. The most commonly reported hallucinations are animals, people of any age, scary or deformed faces and heads, landscapes, or people walking in a line.
113:. Lhermitte provided a full account of his work in this area in his book "Les hallucinations: clinique et physiopathologie," which was published in Paris in 1951 by Doin publishing. Contemporary researchers, with access to new technologies in medical brain imaging, have confirmed the brain localization of these unusual hallucinations.
353:. Later in 1932, Lhermitte, Levy, and Trelles discovered an association between peduncular hallucinosis and “pigmentary degeneration of the periaqueductal gray and the degeneration of the occulomotor nucleus.” Posterior thalamic lesions were also found to be linked to peduncular hallucinosis by De Morsier. More recently,
225:
Other visual hallucinations tend to stem from psychological disorders. Whereas a person with a psychological disorder thinks their hallucinations are real, people with peduncular hallucinosis normally know that the visual hallucinations they see are not real. Peduncular hallucinations are independent
212:
are more prone to complex visual hallucinations such as peduncular hallucinosis. Peduncular hallucinosis is more common in patients with a long duration of
Parkinson's disease and also with a long treatment history, depression, and cognitive impairment. Paranoid delusions are common in these patients
320:
The first documented case of peduncular hallucinosis was by French neurologist and neuropsychiatrist Jean
Lhermitte, which described a 72-year-old woman’s visual hallucinations. The hallucinations occurred during normal conscious state and the patient’s neurological signs were associated with those
87:
that typically occur in dark environments and last for several minutes. Unlike some other kinds of hallucinations, the hallucinations that patients with PH experience are very realistic, and often involve people and environments that are familiar to the affected individuals. Because the content of
183:
The effect lesions on the brainstem have on the ascending reticular activating system (ARAS) has also been hypothesized. It was proposed that since the ARAS plays a role in consciousness and waking, the lesions of the brainstem common to peduncular hallucinosis may “disrupt ARAS impulses from the
255:
Treatment of any kind of complex visual hallucination requires an understanding of the different pathologies in order to correctly diagnose and treat. If a person is taking a pro-hallucinogenic medication, the first step is to stop taking it. Sometimes improvement will occur spontaneously and
179:
can also lead to complex visual hallucinations because the lobes connect to the visual system via the lateral geniculate nucleus and medial pulvinar. In addition, visual processing and salience can be disrupted by thalamic lesions which affect important structures such as the pulvinar.
165:
The lesions that disturb brainstem reticular formation or thalamic targets seem to be the source behind peduncular hallucinosis. For example, lesions affecting the dorsal raphe system can lead to hallucinations by preventing ascending inhibition to the dorsal
238:
Diagnosis can be made by multimodal approach such as by detailed history regarding sleep pattern, vividness of images, intact reality testing, and association of any brain pathology particularly brain stem areas, pons, and mid brain, evidence of any tumor,
174:
and areas proximal to it can remove or alter the inputs coming in from the external environment to the visual system. Peduncular hallucinosis therefore might emanate from disturbances in distal portions of the visual system. Lesions in the frontal and
137:, which is supported by the sleep disturbance characteristic of this syndrome. In most cases, people are aware that the hallucinations are not real. However, some people experience agitation and delusion and mistake their hallucinations for reality.
299:
of the retina, and use of optical correcting devices. Tumor removal can also help to relieve compression in the brain, which can decrease or eliminate peduncular hallucinosis. Some hallucinations may be due to underlying
357:(MRI) has been used to localize lesions in the brain characteristic of peduncular hallucinosis. In 1987, the first case of peduncular hallucinosis was reported in which MRI was used to locate a midbrain lesion.
288:, which prevents the LGN from firing, thereby increasing the inhibition of the LGN. Regular antipsychotics as well as antidepressants can also be helpful in reducing or eliminating peduncular hallucinosis.
125:), hallucinations in which people or animals appear smaller than they would be in real life, are common in cases of peduncular hallucinosis. Most patients exhibit abnormal sleep patterns characterized by
510:
Kumar, R., Wahi, J., Banerji, D., & Sharma, K. (1999). Peduncular
Hallucinosis: An Unusual Sequel to Surgical Intervention in the Suprasellar Region. British Journal of Neurosurgery, 13(5), 500-503.
563:
Howlett, D., Downie, A., Banerjee, A., Tonge, K., & Oakeley, H. (1994). MRI of an
Unusual Case of Peduncular Hallucinosis (Lhermitte's Syndrome). Neuroradiology, 36(2), 121-122.
145:
Peduncular hallucinosis is attributed to a range of various pathologies such as vascular and infectious midbrain, pontine and thalamic lesions, local subarachnoid
333:
of peduncular hallucinosis through an autopsy of a patient. His autopsy revealed the infarction of many areas of the brain including the inferolateral
121:
The hallucinations are normally colorful, vivid images that occur during wakefulness, predominantly at night. Lilliputian hallucinations (also called
188:
reticular formation” and, as a consequence, lead to the sleep disturbances characteristic of peduncular hallucinosis. The use of drugs such as
109:
The accumulation of additional cases by
Lhermitte and by others influenced academic medical debate about hallucinations and about behavioral
538:
FEINBERG W, M., & RAPCSAK S, Z. (1989). Peduncular
Hallucinosis Following Paramedian Thalamic Infarction. Neurology, 39(11), 1535-1536.
192:
may help treat sleep disturbances as it has been found to “improve sleep continuity, sleep quality, and increase slow wave sleep.”
325:
to the midbrain and pons. Von
Bogaert, Lhermitte’s colleague, named this type of hallucination “peduncular,” in reference to the
524:
Benke, T. (2006). Peduncular
Hallucinosis - a Syndrome of Impaired Reality Monitoring. Journal of Neurology, 253(12), 1561-1571.
575:
98:
documented the case of a patient who was experiencing visual hallucinations that were suggestive of localized damage to the
88:
the hallucinations is never exceptionally bizarre, patients can rarely distinguish between the hallucinations and reality.
312:. As described, the type of treatment varies widely depending on the causation behind the complex visual hallucinations.
595:
268:
have been used in some cases to control hallucinations. Since peduncular hallucinosis occurs due to an excess of
122:
554:
Spiegel, D., Eastern
Virginia Medical School Dept. of Psychiatry, interviewed by C. Byars, Oct. 12, 2009.
134:
106:. After other similar case studies were published, this syndrome was labeled "peduncular hallucinosis."
354:
277:
167:
329:, as well as to the midbrain and its surroundings. In 1925, Von Bogaert was the first to describe the
133:. Peduncular hallucinosis has been described as a “release phenomenon” due to damage to the ascending
170:(LGN). This inhibition may hyper-excite the LGN, inducing visual hallucinations. Lesions of the
301:
296:
260:
is not necessary. While there is not a lot of evidence of effective pharmacological treatment,
201:
80:
8:
582:
Paper presented at the 45th
Meeting of the American Academy of Neurology. New York, 1993.
342:
338:
486:
443:
326:
244:
205:
478:
435:
427:
423:
35:
490:
447:
470:
419:
346:
292:
150:
59:
54:
vascular and infectious midbrain, pontine and thalamic lesions, local subarachnoid
350:
330:
265:
257:
474:
261:
176:
95:
578:(broken link, Wayback archive version) Anthony H. Risser and Frank C. Powell:
589:
431:
281:
84:
407:
482:
439:
305:
240:
334:
92:
406:
Mocellin, Ramon; Walterfang, Mark; Velakoulis, Dennis (September 2006).
189:
154:
146:
130:
63:
55:
40:
269:
214:
185:
110:
44:
309:
273:
227:
209:
126:
99:
304:, so in these cases the appropriate treatment includes control of
322:
580:
Lhermitte's Peduncular Hallucinosis - An historical perspective.
66:, and following regional surgical or angiographic interventions.
276:
and serotonin receptors, preventing the overstimulation of the
220:
171:
576:
Lhermitte's Peduncular Hallucinosis: An historical perspective
405:
291:
More invasive treatments include corrective surgery such as
285:
103:
213:
even though the hallucinations can occur during clear
345:, third nerve nucleus, superior cerebellar peduncle,
195:
412:
The Australian and New Zealand Journal of Psychiatry
204:, narcolepsy-cataplexy syndrome, delirium tremens,
408:"Neuropsychiatry of complex visual hallucinations"
461:Benke, Thomas (2006). "Peduncular hallucinosis".
587:
272:, modern antipsychotics are used to block both
221:Differences from other visual hallucinations
230:, unlike some other visual hallucinations.
520:
518:
516:
550:
548:
546:
544:
534:
532:
530:
513:
588:
541:
506:
504:
502:
500:
460:
401:
399:
397:
395:
393:
391:
389:
116:
527:
387:
385:
383:
381:
379:
377:
375:
373:
371:
369:
30:Lhermitte's peduncular hallucinosis
13:
557:
497:
196:Correlation between other diseases
14:
607:
569:
366:
424:10.1080/j.1440-1614.2006.01878.x
454:
1:
360:
250:
233:
123:Alice in Wonderland syndrome
7:
135:reticular activating system
10:
612:
475:10.1007/s00415-0060-0254-4
355:magnetic resonance imaging
315:
278:lateral geniculate nucleus
168:lateral geniculate nucleus
160:
149:, compression by tumors,
83:that causes vivid visual
58:, compression by tumors,
50:
34:
26:
21:
140:
81:neurological phenomenon
73:Peduncular hallucinosis
22:Peduncular hallucinosis
596:Neurological disorders
302:cardiovascular disease
297:laser photocoagulation
200:People diagnosed with
321:characteristic of an
463:Journal of Neurology
208:, and temporal lobe
91:In 1922, the French
343:periaqueductal gray
339:superior colliculus
202:Parkinson's disease
153:, basilar vascular
62:, basilar vascular
327:cerebral peduncles
245:Lewy body dementia
206:Lewy body dementia
117:Signs and symptoms
469:(12): 1561–1571.
70:
69:
16:Medical condition
603:
564:
561:
555:
552:
539:
536:
525:
522:
511:
508:
495:
494:
458:
452:
451:
403:
347:substantia nigra
293:cataract surgery
151:basilar migraine
60:basilar migraine
19:
18:
611:
610:
606:
605:
604:
602:
601:
600:
586:
585:
572:
567:
562:
558:
553:
542:
537:
528:
523:
514:
509:
498:
459:
455:
404:
367:
363:
331:pathophysiology
318:
266:anticonvulsants
258:pharmacotherapy
253:
236:
223:
198:
163:
143:
119:
17:
12:
11:
5:
609:
599:
598:
584:
583:
571:
570:External links
568:
566:
565:
556:
540:
526:
512:
496:
453:
418:(9): 742–751.
364:
362:
359:
317:
314:
262:antipsychotics
252:
249:
235:
232:
222:
219:
197:
194:
177:temporal lobes
162:
159:
142:
139:
118:
115:
96:Jean Lhermitte
85:hallucinations
68:
67:
52:
48:
47:
38:
32:
31:
28:
24:
23:
15:
9:
6:
4:
3:
2:
608:
597:
594:
593:
591:
581:
577:
574:
573:
560:
551:
549:
547:
545:
535:
533:
531:
521:
519:
517:
507:
505:
503:
501:
492:
488:
484:
480:
476:
472:
468:
464:
457:
449:
445:
441:
437:
433:
429:
425:
421:
417:
413:
409:
402:
400:
398:
396:
394:
392:
390:
388:
386:
384:
382:
380:
378:
376:
374:
372:
370:
365:
358:
356:
352:
348:
344:
340:
336:
332:
328:
324:
313:
311:
307:
303:
298:
294:
289:
287:
283:
282:Carbamazepine
279:
275:
271:
267:
263:
259:
248:
246:
242:
231:
229:
218:
216:
211:
207:
203:
193:
191:
187:
181:
178:
173:
169:
158:
156:
152:
148:
138:
136:
132:
128:
124:
114:
112:
107:
105:
101:
97:
94:
89:
86:
82:
78:
74:
65:
61:
57:
53:
49:
46:
42:
39:
37:
33:
29:
25:
20:
579:
559:
466:
462:
456:
415:
411:
319:
306:hypertension
290:
254:
241:parkinsonism
237:
224:
199:
182:
164:
144:
129:and daytime
120:
108:
90:
79:) is a rare
76:
72:
71:
335:red nucleus
93:neurologist
27:Other names
361:References
284:increases
190:Olanzapine
155:hypoplasia
147:hemorrhage
131:drowsiness
64:hypoplasia
56:hemorrhage
41:Psychiatry
432:0004-8674
270:serotonin
251:Treatment
234:Diagnosis
215:sensorium
186:brainstem
111:neurology
45:Neurology
36:Specialty
590:Category
491:25990312
483:17006630
448:12151224
440:16911748
351:pulvinar
310:diabetes
274:dopamine
228:seizures
210:epilepsy
127:insomnia
100:midbrain
323:infarct
316:History
280:(LGN).
161:Lesions
489:
481:
446:
438:
430:
349:, and
172:retina
51:Causes
487:S2CID
444:S2CID
141:Cause
479:PMID
436:PMID
428:ISSN
308:and
286:GABA
264:and
104:pons
102:and
471:doi
467:253
420:doi
226:of
592::
543:^
529:^
515:^
499:^
485:.
477:.
465:.
442:.
434:.
426:.
416:40
414:.
410:.
368:^
341:,
337:,
295:,
247:.
243:,
217:.
77:PH
43:,
493:.
473::
450:.
422::
75:(
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.