A case of complex visual hallucinations caused by a cerebral infarction that centered on the left insular cortex and extended to the corona radiata

Abstract

We report a case of complex visual hallucinations caused by a cerebral infarction extending from the left insular cortex to the corona radiata. The patient was a man in his 60s. Totem pole-shaped birds and common pillows appeared with movement throughout his visual field, and he showed an abnormal emotional reaction to the hallucinations. Over time, the birds disappeared, and the number and frequency of the pillows decreased, but his emotional reaction remained and even increased. At the time of discharge, selective attention disorder remained and the hallucinations persisted. Possible mechanisms of the manifestation of the hallucinations include impaired integration of memory and perceptual information due to insular cortex damage. In addition, the change in emotional reaction may have been related to difficulties in visual information processing and emotional regulation caused by selective attention disorder.