Etiology | Classification and characteristic features | Location | Triggers | Duration | Frequency | Insight | Associated symptoms |
Retinal pathology | Simple Intrinsic motion is common; eg, flashing lights | Monocular or binocular, depending on underlying pathology | Valsalva if due to posterior vitreous detachment | Seconds | Variable | Intact | Possible vision loss per abnormal funduscopic examination |
Vision loss, release hallucinations (Charles Bonnet syndrome) | Simple or complex Can be stationary, have intrinsic motion, or move en bloc | Monocular or binocular, full field or hemifield depending on underlying pathology | Sensory deprivation, decreased arousal | Variable | Frequent, at least weekly, up to multiple times in one day | Often intact | Related to underlying condition |
Migraine | Usually simple and geometric in form; eg, fortification spectra, scintillating scotoma Spread or movement across the visual field over minutes is characteristic | Binocular, usually hemifield Often start centrally and move to periphery | Migraine triggers (eg, lack of sleep, red wine, menses) | Several minutes to an hour | Variable, usually less often than weekly | Intact | Migraine headache, often with nausea, vomiting, photophobia |
Seizures | Simple more common than complex Typically circular and colored Movement across the field is rapid (seconds) | Binocular, hemifield | Usually occur without trigger | Seconds to 1-2 minutes | Variable | Usually intact | Other ictal phenomena (eg, automatisms, deja vu, convulsions), postictal headache common |
Dementia with Lewy bodies, Parkinson disease | Simple or complex | Binocular, full field | Usually no trigger | Variable, usually minutes | Variable, can be daily | Variable, perhaps related to cognitive status | Dementia, parkinsonism |
Alcohol withdrawal | Complex, often associated with auditory and tactile hallucinations | Binocular, full field | Abstinence | Persistent | Persist during withdrawal | Often impaired | Autonomic disturbances, confusion, agitation |
Peduncular hallucinosis | Complex, often associated with auditory and tactile hallucinations | Binocular, full field | More common in evening hours | Variable may persist | Variable | Maybe impaired | Sleep disturbances, other brainstem or diencephalic signs |
Narcolepsy | Complex, often associated with auditory and tactile hallucinations | Binocular, full field | Usually on falling to or on awakening from sleep | Variable, seconds to minutes | Often nightly | Usually intact | Cataplexy, excessive daytime sleepiness, sleep paralysis |
Psychiatric illness | Complex, often associated with auditory and tactile hallucinations | Binocular, full field | No trigger | Variable | Frequent | Usually absent | Disordered thoughts, delusions |
Do you want to add Medilib to your home screen?