Disorders causing visual hallucinations

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	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

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Disorders causing visual hallucinations