Repetitive visual images in severe war head injuries

Out of 20 young inpatients who suffered missile head injuries, two (10%) presented repetitive visual images (RVI). The RVI appeared during wakefulness when relaxed with closed eyes and also at sleep stage I, II and REM, at sleep onset and at sleep end. When the two patients were compared neurologically and psychologically with the other eighteen, the coexistence of combat stress syndrome, diffuse brain lesions, right non-dominant associative area damage and homonymous hemianopia characterised the two RVI patients. RVI do not appear in the absence of the combat stress syndrome even in the presence of the other 3 factors. The sleep may be secondarily contaminated by wakefulness RVI. The presence of disturbed REM temporal distribution and short REM latency indicate the depressive state of these patients. It is hypothesised that a similar brain activity in wakefulness and REM sleep explain the wake dreaming or wakefulness RVI of those patients.