Hallucinatory miniature figures may appear during migraine

מתוך medicontext.co.il
NEW YORK (Reuters Health) – The aura of basilar migraine may present as visions of little people, animals, or fantastic creatures dancing around a room, investigators report.

Dr. K. Podoll, of the University of Technology in Aachen, Germany, and Dr. D. Robinson of Boehringer Ingelheim in the UK, report the case of a 78-year-old woman who had experienced "Lilliputian hallucinations" during migraine headaches for 40 years. She had experienced migraine with aura since age 10. She had other symptoms associated with basilar migraine, including vertigo, diplopia and other sensory and motor disturbances.

This phenomenon was only uncovered in 1982 after the patient participated in a migraine art competition. In her drawing she included what she described as "black beetles with faces that run across the carpet and ceiling." As the researchers report in the December issue of Cephalalgia, the images would disappear when she closed her eyes, and she was aware that they represented an aspect of her migraine.

According to Drs. Podoll and Robinson, four similar cases have previously been reported. One patient described a vision of a tiny dwarf who turned into "a giant gladiator finally striking him on the head." Another patient described "a real dance of small, approximately 15 cm high figures…in very rapid movement." Another individual reported one occasion when he observed "Red Indians crowding around in the room in which he lay."

The authors point out that Lilliputian hallucinations may be a symptom of peduncular hallucinosis, which tends to be associated with mesencephalic or thalamic lesions, vertebrobasilar insufficiency due to severe hypoplasia of a vertebral artery, or as a complication of vertebral angiography. They say this tends to support the notion that such phenomena might represent migraine aura symptoms localized to the brain stem.

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