While Ellen’s complex hallucinations started several weeks after her operation, similar “release” hallucinations may appear almost immediately with sudden damage to the occipital cortex. This was the case with Marlene H., a woman in her fifties who came to see me in 1989. She told me that she had awoken one Friday morning in December 1988 with a headache and visual symptoms. She had had migraines for years, and at first she took this as just another visual migraine. But the visual symptoms were different this time: she saw “flashing lights all over . . . shimmering lights . . . arcs of lightning . . . like a Frankenstein thing,” and these did not go away in a few minutes, like her usual migraine zigzags, but continued all through the weekend. Then, on Sunday evening, the visual disturbances took on a more complex character. In the upper part of the visual field, to the right, she saw a writhing form “like a Monarch caterpillar, black and yellow, its cilia glistening,” along with “incandescent yellow lights, like a Broadway show, going up and down, on and off, nonstop.” Though her doctor had reassured her that this was just “an atypical migraine,” things went from bad to worse. On Wednesday, “the bathtub seemed to be crawling with ants . . . there were cobwebs covering the walls and ceiling . . . people seemed to have lattices on their faces.” Two days later she started to experience gross perceptual disturbances: “My husband’s legs looked really short, distorted, like someone in a trick mirror. It was funny.” But it was less funny, and rather frightening, in the market that afternoon: “Everyone looked ugly, parts of their faces were gone, and eyes—there seemed a blackness in their eyes—everyone looked grotesque.” Cars seemed to appear suddenly to the right. Testing her visual fields, waggling her fingers to either side, Marlene found that she could not see them on the right until they crossed the midline; she had lost all vision to the right side.
It was only at this point, days after her initial symptoms, that she was finally investigated medically. A CAT scan of her brain revealed a large hemorrhage in the left occipital lobe. There was little to be done therapeutically at this stage; one could only hope that there would be some resolution of her symptoms, some healing or adaptation with time.
After some weeks, the hallucinations and perceptual distortions, which had been largely confined to the right side, did start to die down, but Marlene was left with a variety of visual deficits. She could see, at least to one side, but was bewildered by what she saw: “I would have preferred to be blind,” she told me, “instead of not being able to make sense of what I saw. . . . I had to go slowly, deliberately, to put things together. I would see my sofa, a chair—but I couldn’t put it together. It did not add up, at first, to a ‘scene.’ . . . I was a very fast reader before. Now I was slow. The letters looked different.”
“When she looks at her watch,” her husband interpolated, “at first she can’t process it.”
Besides these problems of visual agnosia and visual alexia, Marlene was experiencing a sort of runaway visual imagery, outside her control. At one point, she saw a woman wearing a red dress on the street. Then, she said, “I closed my eyes. This woman, almost puppetlike, was moving around, took on a life of her own. . . . I realize that I had been ‘taken over’ by the image.”
I kept in touch with Marlene at intervals and saw her most recently in 2008, twenty years after her stroke. She no longer had hallucinations, perceptual distortions, or runaway visual imagery. She was still hemianopic, but her remaining vision was good enough for her to travel independently and to work (which involved reading and writing, albeit at her own slow pace).
