June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Visual hallucinations reported by stroke survivors: associations and outcomes.
Author Affiliations & Notes
  • Fiona J Rowe
    University of Liverpool Faculty of Health and Life Sciences, Liverpool, Liverpool, United Kingdom
  • Lauren Hepworth
    University of Liverpool Faculty of Health and Life Sciences, Liverpool, Liverpool, United Kingdom
  • Claire Howard
    Northern Care Alliance NHS Foundation Trust, Salford, Manchester, United Kingdom
  • Kerry Hanna
    University of Liverpool Faculty of Health and Life Sciences, Liverpool, Liverpool, United Kingdom
  • Brin Helliwell
    Patient and Public Involvement, United Kingdom
  • Footnotes
    Commercial Relationships   Fiona Rowe None; Lauren Hepworth None; Claire Howard None; Kerry Hanna None; Brin Helliwell None
  • Footnotes
    Support  NIHR-CDF-2012-05-126
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4091. doi:
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      Fiona J Rowe, Lauren Hepworth, Claire Howard, Kerry Hanna, Brin Helliwell; Visual hallucinations reported by stroke survivors: associations and outcomes.. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4091.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Visual hallucinations are a well-recognised entity frequently occurring after significant visual loss. However, they represent an under-diagnosed condition because of lack of patient reports and lack of questioning by clinicians. This study aimed to profile a prospective cohort of stroke survivors with visual hallucinations in the acute stroke stage.

Methods : This was a large multi-centre prospective epidemiology study. Visual assessment included case history, visual acuity, ocular alignment/motility, visual fields, visual inattention, visual perception and reading ability. This was attempted for all stroke admissions across three acute stroke units in North West England.

Results : Of 1500 consecutive stroke admissions, 49 reported visual hallucinations. Mean age at stroke was 69.41 years (SD 11.20). Stroke was an infarct for 91.8% and haemorrhage for 8.2%: right-sided for 63.3%, left for 28.6% and bilateral for 8.2%. Mean time to diagnosis after stroke onset was 12.02 days (SD 15.83) with 71.4% having a diagnosis of their visual issue at their first orthoptic assessment on the acute stroke unit. The occipital lobe was the most common area affected by stroke for those with visual hallucinations (39.0%). Recovery was full for 24.5%, partial for 49.0% and no reported improvement for the remainder.

Conclusions : The incidence of visual hallucinations was 3.7% in this large prospective acute stroke cohort. Visual hallucinations consisted of formed and unformed images and represented both hallucinations from cortical damage as well as those due to visual loss consequences of stroke. Careful questioning by clinicians is vital to detecting visual hallucinations as patients may not always self-report without prompting.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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