Hallucinations following occipital lobe damage: the pathological activation of visual representations

Neuropsychological investigation of hallucinations may provide insight into the nature of these subjective phenomena, as well as inform theories of perception and recall. We studied a man who described continuous visual hallucinations of object fragments (e.g., lines, corners, patterns) in the left visual field following a stroke in the right occipital cortex. The subject performed normally on standardized measures of visual perception and other cognitive abilities. He had no personality disturbance, and EEG during hallucinations was normal. Review of our records of 211 cases with focal lesions involving visual cortex revealed 5 patients with similar complaints. The hallucinatory experience of such patients probably reflects pathological activation of neural ensembles in the regions bordering an occipital lesion. These regions are presumed to contain records of visual feature fragments which are co-activated by feedback projections in the earliest visual association cortices, where they produce meaningful patterns during normal recall.